["BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 87 Use: For the treatment of protozoan and monogenean A B ectoparasites, some fungi and bacteria in fish. It is strongly C recommended that a proprietary formulation is used initially to avoid D problems related to purity and to enable accurate dosing. Copper E has a low therapeutic index and is toxic to gill tissue. It is commonly F used to treat diseases in marine aquaria by prolonged immersion but G is toxic to invertebrates, elasmobranchs, algae and many plants. H Although copper can be used to treat ectoparasites in freshwater I fish, other remedies are safer. The solubility of copper is reduced at J higher pH and it is absorbed or inactivated by high levels of K calcareous materials and organic matter. Free copper ion levels L must be maintained between 0.15\u20130.20 mg\/l for the chemical to be M effective \u2013 this requires monitoring using a commercial test kit then N adjusting the dose initially twice daily. A stock solution is made by O dissolving 1 gram of copper sulphate pentahydrate (CuSO4 5H2O) in P 250 ml distilled water to produce 1 mg copper\/ml and enables Q accurate dosing of the chemical. Copper can be removed using R inactivated carbon. S T Safety and handling: Normal precautions should be observed. U V Contraindications: Do not use in the presence of invertebrates. W X Adverse reactions: No information available. Y Z Drug interactions: No information available. DOSES Fish: 100 mg\/l by immersion for 1\u20135 minutes; 0.15 mg\/l by prolonged immersion until therapeutic effect (at least 10 days); follow the manufacturer\u2019s recommendations for proprietary formulations. Mammals, Birds, Reptiles, Amphibians: No information available. Corydcepic acid see Mannitol Crisantaspase (Asparaginase, l-Asparginase) (Asparginase*, Elspar*, Erwinase*) POM Formulations: Injectable: vials of 5,000 or 10,000 IU powder for reconstitution. Action: Lymphoid tumour cells are not able to synthesize asparagine and are dependent upon supply from the extracellular fluid. Crisantaspase deprives malignant cells of this amino acid, which results in cessation of protein synthesis and cell death. Use: Main indication is treatment of lymphoid malignancies.","88 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Safety and handling: Cytotoxic drug; see specialist texts for further advice on chemotherapeutic agents. Store in a refrigerator. B Contraindications: Patients with active pancreatitis or a history of pancreatitis. History of anaphylaxis associated with previous C administration. D Adverse reactions: Anaphylaxis may follow administration, especially if repeated. Premedication with an antihistamine is E recommended before administration. Gastrointestinal disturbances, hepatotoxicity and coagulation deficits may also be observed. F Drug interactions: Administration with or before vincristine may G reduce clearance of vincristine and increase toxicity; thus, if used in combination the vincristine should be given 12\u201324 hours before H the enzyme. DOSES I See Appendix for chemotherapy protocols in ferrets. J Mammals: Ferrets: 10,000 IU\/m2 s.c. weekly for the first 3 weeks as part of a chemotherapeutic protocol; Guinea pigs: 10,000 IU\/m2 K s.c., i.m. q3wk. Birds, Reptiles, Amphibians, Fish: No information available. L M Cupric sulphate see Copper sulphate N Cyclophosphamide O (Cyclophosphamide*, Endoxana*) POM P Formulations: Injectable: 100 mg, 200 mg, 500 mg, 1000 mg Q powder for reconstitution. Oral: 50 mg tablets. Action: Metabolites crosslink DNA resulting in inhibition of DNA R synthesis and function. S Use: Treatment of lymphoproliferative diseases, myeloproliferative disease and immune-mediated diseases. The use of T cyclophosphamide in immune-mediated haemolytic anaemia is controversial and therefore it is not recommended as an U immunosuppressant in the management of this disease. May have a role in management of certain sarcomas and carcinomas. Use with V caution in patients with renal failure; dose reduction may be required. Has been used in treatment of lymphosarcoma in W cockatoos and lymphoma in the green iguana. X Safety and handling: Cytotoxic drug; see specialist texts for further advice on chemotherapeutic agents. Y Contraindications: No information available. Z Adverse reactions: Myelosuppression, with the nadir usually occurring 7\u201314 days after the start of therapy depending on species;","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 89 regular monitoring of WBCs recommended. A metabolite of A cyclophosphamide (acrolein) may cause a sterile haemorrhagic B cystitis. The cystitis may be persistent. This risk may be reduced by C increasing water consumption or by giving furosemide to ensure D adequate urine production. Other effects include vomiting, E diarrhoea, hepatotoxicity, nephrotoxicity and a reduction in hair F growth rate. G H Drug interactions: Increased risk of myelosuppression if thiazide I J diuretics given concomitantly. Absorption of orally administered K digoxin may be decreased, may occur several days after dosing. L Barbiturates increase cyclophosphamide toxicity due to increased M rate of conversion to metabolites. Phenothiazines and N chloramphenicol reduce cyclophosphamide efficacy. If administered O with doxorubicin there is an increased risk of cardiotoxicity. Insulin P requirements are altered by concurrent cyclophosphamide. Q R DOSES S T See Appendix for chemotherapy protocols in ferrets. U Mammals: Ferrets: As part of a multi-drug protocol for lymphoma; V Guinea pigs: 300 mg\/m2 i.p. q24h. W Birds: Lymphosarcoma: 200 mg\/m2 intraosseous q7d. X Reptiles: 3 mg\/kg i.v. q2wk as part of a chemotherapy protocol in Y one case report in the green iguana\u2006a. Z Amphibians, Fish: No information available. References a\t Folland DW, Johnston MS, Thamm DH and Reavill D (2011) Diagnosis and management of lymphoma in a green iguana (Iguana iguana). Journal of the American Veterinary Medical Association 239(7), 985\u2013991 Cyclosporin(e) see Ciclosporin Cypermethrin (F10 Germicidal Wound Spray with Insecticide) ESPA Formulations: Topical: various formulations including benzalkonium chloride 0.4 g polyhexanide 0.03 g and cypermethrin 0.25 g spray; barrier ointment and shampoo formulations. Action: Acts as a sodium open-channel blocker, resulting in muscular convulsions and death in arthropods. Use: To repel insects and eliminate fly strike infestations. Safety and handling: Normal precautions should be observed. May be harmful to aquatic organisms. Do not contaminate aquaria, ponds or waterways. Contraindications: Do not use in fish or other aquatic organisms.","90 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Adverse reactions: No adverse reactions reported in small mammals if used at dosage regime advised by manufacturer. B Drug interactions: No information available. C DOSES Mammals: Apply ointment or spray to wound site and repeat if D necessary once a week. May need to be re-applied if the animal is exposed to rain. E Fish: Do not use. Birds, Reptiles, Amphibians: No information available. F G Cyproheptadine H (Periactin*) POM I Formulations: Oral: 4 mg tablet. Action: Binds to and blocks the activation of H1 histamine and J serotonin receptors. K Use: Management of allergic disease and appetite stimulation. Use with caution in cases with urinary retention, angle-closure glaucoma L and pyloroduodenal obstruction. Specific doses for animals have not been determined by pharmokinetic studies and clinical M effectiveness has not been established. N Safety and handling: Normal precautions should be observed. Contraindications: No information available. O Adverse reactions: May cause mild sedation, polyphagia, weight P gain. May reduce seizure threshold. Drug interactions: No information available. Q DOSES R Mammals: Ferrets, Chinchillas, Guinea pigs: 0.5 mg p.o. q12h. Birds, Reptiles, Amphibians, Fish: No information available. S T Cyromazine U (Rearguard) NFA-VPS V Formulations: Topical: 6% solution in ready-to-use bottle with built-in applicator sponge. W Action: Inhibits larval development by inhibiting the deposition of chitin into the cuticle. X Use: Prevention of blowfly strike in rabbits for up to 10 weeks after Y application. To be applied in early summer before any flies are seen. Will not kill adult flies or larger maggots already present, but Z prevents eggs developing into maggots. Bathing the rabbit after application may reduce efficacy so is not recommended.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 91 Safety and handling: Normal precautions should be observed. A B Contraindications: Do not use in rabbits less than 10 weeks of C D age, or pregnant or breeding does. Do not apply to broken skin. E F Adverse reactions: Transient inappetence may occur for 24\u201348h G H after treatment. I J Drug interactions: No information available. K L DOSES M N Mammals: Apply topically to fur from middle of the back to tip of O tail and between back legs q6\u201310wks. P Birds, Reptiles, Amphibians, Fish: No information available. Q R Cytarabine (Cytosine arabinoside, Ara-C) S T (Cytarabine*, Cytosar-U*) POM U V Formulations: Injectable: 100 mg, 500 mg powders for W X reconstitution. Y Z Action: The active nucleotide metabolite ara-CTP is incorporated into DNA and inhibits pyrimidine and DNA synthesis. Cytarabine is therefore S phase-specific. Use: Management of lymphoma in the ferret. Safety and handling: Cytotoxic drug; see specialist texts for further advice on chemotherapeutic agents. After reconstitution, store at room temperature and discard after 48 hours or if a slight haze develops. Contraindications: Do not use if there is evidence of bone marrow suppression or substantial hepatic impairment. Adverse reactions: Vomiting, diarrhoea, leucopenia. As it is a myelosuppressant, careful haematological monitoring is required. Conjunctivitis, oral ulceration, hepatotoxicity and fever have also been seen. Drug interactions: Oral absorption of digoxin is decreased. Activity of gentamicin may be antagonized. Simultaneous administration of methotrexate increases the effect of cytarabine. DOSES See Appendix for chemotherapy protocols in ferrets. Mammals: Ferrets: 1 mg\/animal p.o., s.c. q24h for 2 days. Birds, Reptiles, Amphibians, Fish: No information available.","92 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Deferoxamine (Desferrioxamine) B (Desferal*) POM C Formulations: Injectable: 500 mg vial for reconstitution. Action: Deferoxamine chelates iron, and the complex is excreted in D the urine. E Use: To remove iron from the body following poisoning. Also used for haemochromatosis (common in toucans, hornbills and softbills, F though unusual in other birds). Safety and handling: Normal precautions should be observed. G Contraindications: Avoid in severe renal disease. H Adverse reactions: Administration i.m. is painful. Anaphylactic I reactions and hypotension may develop if administered rapidly i.v. Drug interactions: No information available. J DOSES K Birds: Various doses proposed, ranging from 20 mg\/kg p.o. q4h to 40 mg\/kg i.m. q24h (mynahs) to 100 mg\/kg p.o., s.c., i.m. q24h for L up to 14 weeks\u2006a,1. Mammals, Reptiles, Amphibians, Fish: No information available. M References a\t Dierenfeld E and Phalen DN (2006) A comparison of four regiments for treatment of N iron storage disease using the European Starling (Sturnus vulgaris) as a model. Journal of Avian Medicine and Surgery 20(2), 74\u201379 O 1\t Sheppard C and Dierenfeld E (2002) Iron storage disease in birds: speculation on etiology and implications for captive husbandry. Journal of Avian Medicine and Surgery 16(3), 192\u2013197 P Q Delmadinone R (Tardak) POM-V Formulations: Injectable: 10 mg\/ml suspension. S Action: Progestogens suppress FSH and LH production. T Use: In birds it may be useful for behavioural regurgitation or U behaviour associated with sexual frustration. Can also be used to assess the effects of chemical castration prior to surgical castration V in rats. Safety and handling: Normal precautions should be observed. W Contraindications: No information available. X Adverse reactions: Possible adverse effects include a transient reduction in fertility and libido, polyuria and polydipsia, an increased Y appetite, and hair colour change at the site of injection. Z Drug interactions: Cortisol response to ACTH stimulation is significantly suppressed after just one dose of delmadinone.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 93 DOSES A B Mammals: Rats: 1 mg\/animal i.m, s.c. C Birds: 1 mg\/kg i.m. once. D Reptiles, Amphibians, Fish: No information available. E F Desferrioxamine see Deferoxamine G H Deslorelin I J (Suprelorin) POM-V K L Formulations: Implant containing 4.7 mg or 9.4 mg of active M N product. O P Action: Desensitizes GnRH receptors, thereby decreasing release Q R of LH and FSH. This leads to reduction in testosterone and sperm S production. T U Use: Chemical contraception in susceptible species. In males, there V W is a 14-day surge in testosterone followed by lowering of levels. X Infertility is achieved from 6 weeks up to at least 6 months after Y initial treatment. Treated male animals should therefore still be kept Z away from females within the first 6 weeks following initial treatment. Any mating that occurs more than 6 months after the administration of the product may result in pregnancy. Disinfection of the site should be undertaken prior to implantation to avoid introduction of infection. If the hair is long, a small area should be clipped, if required. The product should be implanted subcutaneously in the loose skin on the back between the lower neck and the lumbar area. Avoid injection of the implant into fat, as release of the active substance might be impaired in areas of low vascularization. The biocompatible implant does not require removal. However, should it be necessary to end treatment, implants may be surgically removed. Implants can be located using ultrasonography. Deslorelin implants effectively prevent reproduction and the musky odour of intact male and female ferrets, and are therefore considered a suitable alternative for surgical neutering in these animals. Surgical neutering of ferrets has been implicated as an aetiological factor in the development of hyperadrenocorticism in this species. Deslorelin implants can be given to neutered ferrets to decrease the development or progression of adrenocortical disease. In rabbits, the effects on reproductive behaviour and fertility are considered negligible in males\u2006a, although implants appear to reduce ovarian activity if placed prior to puberty in females\u2006b. However, the possibility of masking future uterine pathology makes use in rabbits difficult to advise without careful monitoring. The use of the implant in birds and reptiles has been reported for a range of behavioural and reproductive (e.g. excessive egg laying) disorders but with variable effect and duration of action between species. In Quaker parrots","94 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A and cockatiels, one study showed a 6 month prevention of egg laying using a 4.7 mg implant\u2006c. In male birds, has been used to B counter aggressive behaviour with variable response. Has also been used for management of a Sertoli cell tumour in budgerigars and C ovarian neoplasia in cockatiels\u2006d,e. Safety and handling: Pregnant women should not administer D the product. E Contraindications: No information available. Adverse reactions: Moderate swelling at the implant site may be F observed for 14 days. A significant decrease in testicle size will be seen during the treatment period. In very rare cases, a testicle may G be able to ascend the inguinal ring. H Drug interactions: No information available. DOSES I Mammals: Ferrets: 1 implant per animal. The 9.4 mg implant J (authorized in males only) lasts approximately 3\u20134 years. The 4.7 mg implant is not authorized in either sex and lasts approximately 1\u20132 K years. Females will come into oestrus for approximately 2 weeks after implantation; Guinea pigs: 1 implant per animal for L contraception in females, although appears ineffective in males\u2006f; Rats: 1 implant per animal provides contraceptive and reduced M reproductive behaviour effects for >1 year in males and females; Others: Effects are variable and depend on the exact pathology, N species and sex. Birds, Reptiles, Amphibians: 1 implant per animal regardless of O size, placed subcutaneously. The 9.4 mg implant appears to last longer than the 4.7 mg but duration of either is variable. P Fish: No information available. Q References a\t Goericke-Pesch S, Groeger G and Wehrend A (2015) The effects of a slow release GnRH agonist implant on male rabbits. Animal Reproduction Science 152, 83\u201389 R b\t Geyer A, Daub L, Otzdorff C et al. (2016) Reversible estrous cycle suppression in prepubertal female rabbits treated with slow-release deslorelin implants. S Theriogenology 85(2), 282\u2013287 c\t Petritz OA, Sanchez-Migallon Guzman D, Paul-Murphy J et al. (2013) Evaluation of the efficacy and safety of single administration of 4.7 mg deslorelin acetate implants on T egg production and plasma sex hormones in Japanese quail (Coturnix coturnix japonica). American Journal of Veterinary Research 74(2), 316\u2013323 d\t Keller KA, Beaufr\u00e8re H, Brand\u00e3o J et al. (2013) Long-term management of ovarian U neoplasia in two cockatiels (Nymphicus hollandicus). Journal of Avian Medicine and Surgery 27(1), 44\u201352 V e\t Straub J and Zenker I (2013) First experience in hormonal treatment of sertoli cell tumors in budgerigars (M. undulates) with absorbable extended release GnRH chips (Suprelorin\u00ae). 1st International Conference on Avian, Herpetological and Exotic W Mammal Medicine. Wiesbaden, pp. 299\u2013301 f\t Forman C, Wehrend A and Goericke-Pesch S (2016) Deslorelin implants are suitable for contraception in female, but not male guinea pigs. Proceedings of the 8th X International Symposium on Canine and Feline Reproduction, Paris Y Z","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 95 Dexamethasone A B (Aurizon, Dexadreson, Dexafort, Dexa-ject, C Rapidexon, Voren, Dexamethasone*, Maxidex*, D Maxitrol*) POM-V E F Formulations: Ophthalmic: 0.1% solution (Maxidex, Maxitrol). G H Maxitrol also contains polymyxin B and neomycin. Injectable: 2 mg\/ I ml solution; 1 mg\/ml, 3 mg\/ml suspension; 2.5 mg\/ml suspension J with 7.5 mg\/ml prednisolone. Oral: 0.5 mg tablet. (1 mg of K dexamethasone is equivalent to 1.1 mg of dexamethasone acetate, L 1.3 mg of dexamethasone isonicotinate or dexamethasone sodium M phosphate, or 1.4 mg of dexamethasone trioxa-undecanoate.) N O Action: Alters the transcription of DNA, leading to alterations in P Q cellular metabolism which cause a reduction in inflammatory response. R S Use: Anti-inflammatory drug. Also used to prevent and treat T U anaphylaxis associated with transfusion or chemotherapeutic V agents. Anti-inflammatory potency is 7.5 times greater than W prednisolone. On a dose basis 0.15 mg dexamethasone is equivalent X to 1 mg prednisolone. Dexamethasone has a long duration of action Y and low mineralocorticoid activity and is particularly suitable for Z short-term high-dose therapy in conditions where water retention would be a disadvantage. Unsuitable for long-term daily or alternate-day use. Animals on chronic therapy should be tapered off steroids when discontinuing the drug. Use shorter-acting preparations wherever possible in birds and rabbits. The use of long-acting steroids in most cases of shock and spinal injury is of no benefit and may be detrimental. Used for the treatment of shock, trauma and chronic stress in fish. Safety and handling: Normal precautions should be observed. Contraindications: Do not use in pregnant animals. Systemic corticosteroids are generally contraindicated in patients with renal disease and diabetes mellitus. Impaired wound healing and delayed recovery from infections may be seen. Topical corticosteroids are contraindicated in ulcerative keratitis. Adverse reactions: A single dose of dexamethasone or dexamethasone sodium phosphate suppresses adrenal gland function for up to 32 hours. Prolonged use of glucocorticoids suppresses the hypothalamic-pituitary axis (HPA), causing adrenal atrophy, elevated liver enzymes, cutaneous atrophy, weight loss, PU\/ PD, vomiting and diarrhoea. GI ulceration may develop. Hyperglycaemia and decreased serum T4 values may be seen in patients receiving dexamethasone. Corticosteroids should be used with care in birds as there is a high risk of immunosuppression and side effects, such as hepatopathy and a diabetes mellitus-like syndrome. In rabbits, even small single doses can potentially cause severe adverse reactions. Ferrets are particularly susceptible to GI ulceration, and concurrent gastric protectants may be advisable, especially in stressed animals.","96 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Drug interactions: There is an increased risk of GI ulceration if used concurrently with NSAIDs. The risk of developing hypokalaemia B is increased if corticosteroids are administered concomitantly with amphotericin B or potassium-depleting diuretics (furosemide, C thiazides). Dexamethasone antagonizes the effect of insulin. Phenobarbital or phenytoin may accelerate the metabolism of D glucocorticoids and antifungals (e.g. itraconazole) may decrease it. DOSES E Mammals: Ophthalmic: Apply small amount of ointment to F affected eye(s) q6\u201324h or 1 drop of solution in affected eye(s) q6\u201312h. Ferrets: 0.5\u20132.0 mg\/kg s.c., i.m., i.v. q24h; 1 mg\/kg i.m., i.v. G once followed with prednisolone (post adrenalectomy); Rabbits: 0.2\u20130.6 mg\/kg s.c., i.m., i.v. q24h; Guinea pigs: 0.6 mg\/kg i.v., i.m., H s.c. q24h (pregnancy toxaemia); Primates: 0.5\u20132 mg\/kg i.v., i.m., s.c. once (cerebral oedema); 0.25\u20131 mg\/kg i.v., i.m., s.c. q24h I (inflammation); Sugar gliders: 0.5\u20132 mg\/kg s.c., i.m., i.v.; Others: anti-inflammatory: 0.055\u20130.2 mg\/kg i.m., s.c. q12\u201324h tapering J dose over 3\u201314 days. Birds: 2\u20136 mg\/kg i.v., i.m. q12\u201324h. K Reptiles: Inflammation, non-infectious respiratory disease: 2\u20134 mg\/kg i.m., i.v. q24h for 3 days. L Amphibians: 1.5 mg\/kg s.c., i.m. q24h. Fish: 1\u20132 mg\/kg i.m., intracoelomic or 10 mg\/l for 60 minute bath M q12\u201324h. N Dexmedetomidine O (Dexdomitor) POM-V P Formulations: Injectable: 0.1 mg\/ml, 0.5 mg\/ml solution. Q Action: Agonist at peripheral and central alpha-2 adrenoreceptors producing dose-dependent sedation, muscle relaxation and analgesia. R Use: To provide sedation and premedication when used alone or in S combination with opioid analgesics and may also provide additional analgesia. Dexmedetomidine combined with ketamine can be used T to provide a short duration (20\u201330 min) of surgical anaesthesia. Dexmedetomidine is the pure dextroenantiomer of medetomidine. U As the levomedetomidine enantiomer is largely inactive, dexmedetomidine is twice as potent as the racemic mixture V (medetomidine). Administration of dexmedetomidine reduces the biological load presented to the animal, resulting in quicker W metabolism of concurrently administered anaesthetic drugs and a potentially faster recovery from anaesthesia. Dexmedetomidine is a X potent drug that causes marked changes in the cardiovascular system, including an initial peripheral vasoconstriction that results in Y an increase in blood pressure and a compensatory bradycardia. After 20\u201330 min vasoconstriction wanes, while blood pressure returns to Z normal values. Heart rate remains low due to the central sympatholytic effect of alpha-2 agonists. These cardiovascular","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 97 changes result in a fall in cardiac output; central organ perfusion is A well maintained at the expense of redistribution of blood flow away B from the peripheral tissues. Respiratory system function is well C maintained; respiration rate may fall but is accompanied by an D increased depth of respiration. Oxygen supplementation is advisable E in all animals that have received dexmedetomidine for sedation. F Combining dexmedetomidine with an opioid provides improved G analgesia and sedation. Lower doses of dexmedetomidine should be H used in combination with other drugs. Reversal of dexmedetomidine I sedation or premedication with atipamezole at the end of the J procedure shortens the recovery period, which is advantageous. K Analgesia should be provided with other classes of drugs before L atipamezole. High doses (>10 \u03bcg\/kg) are associated with greater M physiological disturbances than doses of 1\u201310 \u03bcg\/kg. Using N dexmedetomidine in combination with opioids in the lower dose O range can provide good sedation and analgesia with minimal side P effects. The lower concentration of dexmedetomidine is designed to Q increase the accuracy of dosing in smaller species. R S Safety and handling: Normal precautions should be observed. T U Contraindications: Do not use in animals with cardiovascular or V W other systemic disease. Use of dexmedetomidine in geriatric patients X is not advisable. It should not be used in pregnant animals, nor in Y animals likely to require or receiving sympathomimetic amines. Z Adverse reactions: Causes diuresis by suppressing ADH secretion, a transient increase in blood glucose by decreasing endogenous insulin secretion, and mydriasis and decreased intraocular pressure. Vomiting after i.m. administration is common, so dexmedetomidine should be avoided when vomiting is contraindicated (e.g. foreign body, raised intraocular pressure). Due to effects on blood glucose, use in diabetic animals is not recommended. Spontaneous arousal from deep sedation following stimulation can occur with all alpha-2 agonists, aggressive animals sedated with dexmedetomidine must still be managed with caution. Drug interactions: No information available. DOSES When used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species. Mammals: Ferrets: 0.04\u20130.1 mg\/kg s.c., i.m.; Rabbits: 0.025\u20130.05 mg\/kg i.v. or 0.05\u20130.15 mg\/kg s.c., i.m. Birds: Buzzards: 0.1 mg atropine + 25 \u03bcg (micrograms)\/kg dexmedetomidine i.m.; Kestrels: 0.05 mg atropine + 75 \u03bcg\/kg dexmedetomidine i.m. as induction for isoflurane general anaesthesia\u2006a. Reptiles: Usually combined with ketamine and\/or opioids\/ midazolam to provide light anaesthesia (see Appendix). Tegus: 0.2 mg\/kg (analgesia)\u2006b; Ball pythons: 0.1\u20130.2 mg\/kg (sedation or possible analgesia)\u2006c. Amphibians, Fish: No information available.","98 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Referencesa\t Santangelo B, Ferrari D, Di Martino I et al. (2009) Dexmedetomidine chemical restraint of two raptor species undergoing inhalation anaesthesia. Veterinary Research B Communications 33(1), 209\u2013211 b\t Bisetto SP, Melo CF and Carregaro AB (2018) Evaluation of sedative and C antinociceptive effects of dexmedetomidine, midazolam and dexmedetomidine\u2013 midazolam in tegus (Salvator merianae). Veterinary Anaesthesia and Analgesia 45(3), 320\u2013328 D c\t Bunke LG, Sladky KK and Johnson SM (2018) Antinociceptive efficacy and respiratory effects of dexmedetomidine in ball pythons (Python regius). American Journal of Veterinary Research 79(7), 718\u2013726 E F Dextrose see Glucose G Diazepam H (Dialar*, Diazemuls*, Diazepam Rectubes*, I Rimapam*, Stesolid*, Tensium*, Valclair*, Valium*) J POM K Formulations: Injectable: 5 mg\/ml emulsion (2 ml ampoules, Diazemuls). Oral: 2 mg, 5 mg, 10 mg tablets; 2 mg\/5 ml solution. L Rectal: 2 mg\/ml (1.25, 2.5 ml tubes), 4 mg\/ml (2.5 ml tubes) solutions; 10 mg suppositories. M Action: Enhances activity of the major inhibitory central nervous N system neurotransmitter, gamma-aminobutyric acid (GABA), through binding to the benzodiazepine site of the GABAA receptor. O Use: Anticonvulsant, anxiolytic and skeletal muscle relaxant (e.g. urethral muscle spasm and tetanus). Diazepam is the drug of choice P for the short-term emergency control of severe epileptic seizures and status epilepticus. In guinea pigs it may be used to reduce the Q excitability associated with extreme pruritus (e.g. with ectoparasitic infestations). It may also be used in combination with ketamine to R offset muscle hypertonicity associated with ketamine, and with opioids and\/or acepromazine for pre-anaesthetic medication in the S critically ill. It provides very poor sedation or even excitation when used alone in healthy animals. Used in birds for the short-term T management of feather plucking. Diazepam has a high lipid solubility, which facilitates its oral absorption and rapid central U effects. Liver disease will prolong duration of action. In the short term repeated doses of diazepam or a CRI will lead to drug V accumulation and prolonged recovery. Flumazenil (a benzodiazepine antagonist) will reverse the effects of diazepam. The W development of dependence on benzodiazepines may occur after regular use, even with therapy of only a few weeks, and the dose X should be gradually reduced in these cases if the benzodiazepine is being withdrawn. Y Safety and handling: Substantial adsorption of diazepam may Z occur on to some plastics and this may cause a problem when administering diazepam by continuous i.v. infusion. The use of","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 99 diazepam in PVC infusion bags should be avoided; giving sets should A be kept as short as possible and should not contain a cellulose B propionate volume-control chamber. If diazepam is given by C continuous i.v. infusion the compatible materials include glass, D polyolefin, polypropylene and polyethylene. E F Contraindications: Benzodiazepines should be avoided in G H patients with CNS depression, respiratory depression, severe muscle I weakness or hepatic impairment (as may worsen hepatic J encephalopathy). They are also contraindicated in the long-term K treatment of behavioural disorders due to the risks of disinhibition L and interference with memory and learning. M N Adverse reactions: Sedation, muscle weakness and ataxia are O P common. Rapid i.v. injection or oral overdose may cause marked Q paradoxical excitation (including aggression) and elicit signs of pain; R i.v. injections should be made slowly (over at least 1 minute for each S 5 mg). Intramuscular injection is painful and results in erratic drug T absorption. Rectal administration is effective for emergency control U of seizures if i.v. access is not possible, but the time to onset is V delayed to 5\u201310 min. The duration of action may be prolonged after W repeated doses in rapid succession, in older animals, those with liver X dysfunction and those receiving beta-1 antagonists. Chronic dosing Y leads to a shortened half-life due to activation of the hepatic Z microsomal enzyme system and tolerance to the drug may develop. The propylene glycol formulation of injectable diazepam can cause thrombophlebitis, therefore the emulsion formulation is preferred for i.v. injection. Drug interactions: Do not dilute or mix with other agents. Due to extensive metabolism by the hepatic microsomal enzyme system, interactions with other drugs metabolized in this way are common. Cimetidine and omeprazole inhibit metabolism of diazepam and may prolong clearance. Concurrent use of phenobarbital may lead to a decrease in the half-life of diazepam. An enhanced sedative effect may be seen if antihistamines or opioid analgesics are administered with diazepam, and diazepam will reduce the dose requirement of other anaesthetic agents. When given with diazepam the effects of digoxin may be increased. Diazepam may be used in combination with tricyclic antidepressant therapy for the management of more severe behavioural responses. DOSES When used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species. Mammals: Ferrets: seizures: 2\u20135 mg\/kg i.m. once; urethral sphincter muscle relaxation post urinary catheterization or obstruction: 0.5 mg\/kg p.o., i.m., i.v. q6\u20138h; Rabbits: epileptic seizures, pre-anaesthetic sedation, muscle relaxation: 1\u20135 mg\/kg i.v.; Guinea pigs: 0.5\u20135.0 mg\/kg i.m. as required; Chinchillas, Rats, Mice, Hamsters, Gerbils: 2.5\u20135 mg\/kg i.m., i.p. once; Primates: sedation and seizures: 0.5\u20131 mg\/kg p.o., i.m.; Sugar gliders, Hedgehogs: sedation and seizures: 0.5\u20132 mg\/kg p.o., s.c., i.m.","100 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Birds: Epileptic seizures: 0.1\u20131 mg\/kg i.v., i.m. once; Appetite stimulant in raptors: 0.2 mg\/kg p.o. q24h. B Reptiles: Epileptic seizures: 2.5 mg\/kg i.m., i.v. Amphibians, Fish: No information available. C D Diazoxide E (Eudemine*) POM Formulations: Injectable: 15 mg\/ml solution. Oral: 50 mg tablet. F Action: A diuretic that causes vasodilation and inhibits insulin G secretion by blocking calcium mobilization. H Use: Used to manage hypoglycaemia caused by hyperinsulinism due to insulinoma in ferrets. In humans it is also used in the short- I term management of acute hypertension. Safety and handling: Normal precautions should be observed. J Contraindications: No information available. K Adverse reactions: The commonest adverse effects are anorexia, vomiting and diarrhoea. Hypotension, tachycardia, bone marrow L suppression, pancreatitis, cataracts and electrolyte and fluid retention may occur. Drug efficacy may diminish over a period of months. M Drug interactions: Phenothiazines and thiazide diuretics may N increase the hyperglycaemic activity of diazoxide, whilst alpha- adrenergic blocking agents (e.g. phenoxybenzamine) may O antagonize the effects of diazoxide. DOSES P Mammals: Ferrets: 5\u201330 mg\/kg p.o. q12h. Q Birds, Reptiles, Amphibians, Fish: No information available. R Diclofenac S (Voltarol Ophtha*, Voltarol Ophtha Multidose*) T POM U Formulations: Ophthalmic: 0.1% solution in 5 ml bottle and in single-use vial. V Action: COX inhibitor that produces local anti-inflammatory effects. W Use: Used in cataract surgery to prevent intraoperative miosis and X reflex (axonal) miosis caused by ulcerative keratitis. Used to control pain and inflammation associated with corneal surgery and in Y ulcerative keratitis when topical corticosteroid use is contraindicated. Safety and handling: Normal precautions should be observed. Z Contraindications: No information available.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 101 Adverse reactions: As with other topical NSAIDs, diclofenac may A B cause local irritation. Topical NSAIDs should be used with caution in C ulcerative keratitis as they can delay epithelial healing. Topical NSAIDs, D and most specifically diclofenac, have been associated with an E increased risk of corneal \u2018melting\u2019 (keratomalacia) in humans, F although this has not been reported in the veterinary literature. G Topical NSAIDs have the potential to increase intraocular pressure and H should be used with caution in animals predisposed to glaucoma. I Regular monitoring is advised. Use of systemic formulations has been J associated with death in some species of birds. K L Drug interactions: Ophthalmic NSAIDs may be used safely with M N other ophthalmic pharmaceuticals, although concurrent use of O drugs which adversely affect the corneal epithelium (e.g. P gentamicin) may lead to increased corneal penetration of the NSAID. Q The concurrent use of topical NSAIDs with topical corticosteroids R has been identified as a risk factor in humans for precipitating S corneal problems. T U DOSES V W Mammals: Topically as required (from 1 drop every 30 mins for 2 X hours prior to cataract surgery, to 1 drop q4h for general anti- Y inflammatory effects)\u2006a. Z Birds: Not recommended (see note above on adverse reactions). Reptiles, Amphibians, Fish: No information available. References a\t Waterbury L and Flach A (2006) Comparison of ketorolac tromethamine, diclofenac sodium and loteprednol etabonate in an animal model of ocular inflammation. Journal of Ocular Pharmacology and Therapeutics 22, 155\u2013159 Diflubenzuron (Dimilin) (Aradol, CestoNemEx, Parazin) ESPA Formulations: Immersion: 1 g\/l (CestoNemEx), 1.64 g\/l (Aradol); 4 g tablet for dissolution in water (Parazin). Action: Inhibits chitin synthesis during ecdysis (moulting) of exoskeleton in crustacean parasites. Use: Treatment of crustacean ectoparasites in fish (e.g. Argulus, Ergasilus, Lernaea). Only effective during moulting of immature life stages of the parasites, including eggs, but not adults. It is highly toxic to non-target species and must not be used in the presence of invertebrates. It is persistent in the environment. Some formulations may require approval for use from relevant authorities in some countries. Safety and handling: Normal precautions should be observed. Contraindications: Do not use in the presence of aquatic invertebrates. Adverse reactions: No information available.","102 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Drug interactions: No information available. DOSES B Fish: 0.03 mg\/l by prolonged immersion or 0.01 mg\/l by prolonged C immersion q6d for 3 treatments\u20061,2; follow the manufacturer\u2019s recommendations for proprietary formulations. D Mammals, Birds, Reptiles, Amphibians: No information available. E References 1\t Noga EJ (2010) Fish Disease Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, F Oxford 2\t Stoskopf MK (1993) Fish Medicine. Saunders, Philadelphia G Digoxin H (Digoxin*, Lanoxin*, Lanoxin PG*) POM I Formulations: Oral: 62.5 \u03bcg, 125 \u03bcg, 250 \u03bcg tablets; 50 \u03bcg\/ml J elixir. Injectable: 100 \u03bcg\/ml, 250 \u03bcg\/ml. Action: Inhibits Na+\/K+ ATPase, leading to an increase in K intracellular sodium. Sodium is exchanged for calcium, resulting in an increase in intracellular calcium and hence a mild positive L inotropic effect. Digoxin slows the heart rate by decreasing the rate of sinoatrial node firing and inhibiting AV nodal conduction. These M effects result primarily from parasympathetic activation and sympathetic inhibition, although it may also produce a modest N direct depression of nodal tissue. The combination of a slower heart rate and increased force of contraction increases cardiac output in O patients with supraventricular tachyarrhythmias. Digoxin improves baroreceptor reflexes that are impaired in heart failure. P Use: Management of heart failure and supraventricular Q tachyarrhythmias. It is primarily used to control the ventricular rate in cases of heart failure with concurrent atrial fibrillation. Digoxin\/ R diltiazem combination therapy results in more effective rate control than monotherapy. In ferrets and rabbits it is used in the treatment S of dilated cardiomyopathy. Serum levels should be checked after 5\u20137 days, with a sample taken at least 8 hours post-pill. The T bioavailability of digoxin varies between the different formulations: i.v. = 100%; tablets = 60%; and elixir = 75%. If toxic effects are seen U or the drug is ineffective, serum levels of digoxin should be assessed; the ideal therapeutic level is a trough serum concentration V in the region of 1 ng\/ml to optimize beneficial effects and minimize toxic side effects, with a suggested range of 0.6\u20131.2 ng\/ml. W Decreased dosages or an increase in dosing intervals may be required in geriatric patients, obese animals or those with significant X renal dysfunction. The intravenous route is rarely indicated and, if used, should be done very slowly and with extreme care. Y Safety and handling: Normal precautions should be observed. Z Contraindications: Frequent ventricular arrhythmias or atrioventricular block.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 103 Adverse reactions: Hypokalaemia predisposes to toxicity in all A B species. Signs of toxicity include anorexia, vomiting, diarrhoea, C depression or arrhythmias (e.g. AV block, bigeminy, paroxysmal D ventricular or atrial tachycardias with block, and multiform E ventricular premature contractions). Lidocaine and phenytoin may F be used to control digoxin-associated arrhythmias. Intravenous G administration may cause vasoconstriction. H I Drug interactions: Antacids, chemotherapy agents (e.g. J K cyclophosphamide, cytarabine, doxorubicin, vincristine), cimetidine L and metoclopramide may decrease digoxin absorption from the GI M tract. The following may increase the serum level, decrease the N elimination rate or enhance the toxic effects of digoxin: O amiodarone, antimuscarinics, diazepam, erythromycin, loop and P thiazide diuretics (hypokalaemia), oxytetracycline, quinidine and Q verapamil. Spironolactone may enhance or decrease the toxic R effects of digoxin. S T DOSES U V Mammals: Ferrets: 5\u201310 \u03bcg (micrograms)\/kg p.o. q12\u201324h; W Rabbits: 3\u201330 \u03bcg\/kg p.o. q24\u201348h; Hamsters: 0.05\u20130.1 mg\/kg p.o. X q12\u201324h; Primates: 0.02\u20130.12 mg\/kg i.m., i.v. q12\u201324h; Y Hedgehogs: 10 \u03bcg\/kg p.o. q12\u201324h. Z Birds: Raptors: 0.02\u20130.05 mg\/kg p.o. q12h for 2\u20133 days then reduce to 0.01 mg\/kg p.o. q12\u201324h; Pigeons, Parrots: 0.02\u20130.05 mg\/kg p.o. q24h\u2006a,1. Reptiles, Amphibians, Fish: No information available. References a\t Wilson RC, Zenoble RD, Horton Jr CR and Ramsey DT (1989) Single Dose Digoxin Pharmacokinetics in the Quaker Conure (Myiopsitta monachus). Journal of Zoo and Wildlife Medicine 20(4), 432\u2013434 1\t Fitzgerald BC, Dias S and Martorell J (2018) Cardiovascular Drugs in Avian, Small Mammal, and Reptile Medicine. Veterinary Clinics of North America: Exotic Animal Practice 21(2), 399\u2013442 Diltiazem (Hypercard, Dilcardia SR*) POM-V, POM Formulations: Oral: 10 mg (Hypercard), 60 mg (generic) tablets. Long-acting preparations authorized for humans, such as Dilcardia SR (60 mg, 90 mg, 120 mg capsules), are available but their pharmacokinetics have been little studied in animals to date. Action: Inhibits inward movement of calcium ions through slow (l-type) calcium channels in myocardial cells, cardiac conduction tissue and vascular smooth muscle; vascular smooth muscle is more sensitive to diltiazem than myocardial tissues (relative activity of 7:1). Diltiazem causes a reduction in myocardial contractility (negative inotrope, although less effective than verapamil), depressed electrical activity (retarded atrioventricular conduction) and decreases vascular resistance (vasodilation of cardiac vessels and peripheral arteries and arterioles).","104 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Use: Used in ferrets and rabbits as in other species to control supraventricular tachyarrhythmias and for hypertrophic B cardiomyopathy. Used to decrease the ventricular rate in atrial fibrillation either as monotherapy or in combination with digoxin. C Digoxin\/diltiazem combination therapy results in more effective rate control than monotherapy. Diltiazem is preferred to verapamil by D many because it has effective antiarrhythmic properties with minimal negative inotropy. Diltiazem is less effective than E amlodipine in the management of hypertension. Reduce the dose in patients with hepatic or renal impairment. F Safety and handling: Normal precautions should be observed. G Contraindications: Diltiazem is contraindicated in patients with second- or third-degree AV block, marked hypotension or sick sinus H syndrome, and should be used cautiously in patients with systolic dysfunction or acute or decompensated congestive heart failure. I Adverse reactions: No information available. J Drug interactions: If diltiazem is administered concurrently with beta-adrenergic blockers (e.g. propranolol), there may be additive K negative inotropic and chronotropic effects. The co-administration of diltiazem and beta-blockers is not recommended. The activity of L diltiazem may be adversely affected by calcium salts or vitamin D. There are conflicting data regarding the effect of diltiazem on serum M digoxin levels and monitoring of these levels is recommended if the drugs are used concurrently. Cimetidine inhibits the metabolism of N diltiazem, thereby increasing plasma concentrations. Diltiazem enhances the effect of theophylline, which may lead to toxicity. It O may affect quinidine and ciclosporin concentrations. Diltiazem may displace highly protein-bound agents from plasma proteins. P Diltiazem may increase intracellular vincristine levels by inhibiting outflow of the drug from the cell. Q DOSES R Mammals: Ferrets: 1.5\u20137.5 mg\/kg p.o. q12h; Rabbits: 0.5\u20131.0 mg\/ kg p.o. q12\u201324h. S Birds, Reptiles, Amphibians, Fish: No information available. T Dimercaprol (British anti-lewisite) U (Dimercaprol*) POM V Formulations: Injectable: 50 mg\/ml solution in peanut oil. W Action: Chelates heavy metals. X Use: Treatment of acute toxicity caused by arsenic, gold, bismuth and mercury, and used as an adjunct (with edetate calcium Y disodium) in lead poisoning. Safety and handling: Normal precautions should be observed. Z Contraindications: Severe hepatic failure.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 105 Adverse reactions: Intramuscular injections are painful. A B Dimercaprol\u2013metal complexes are nephrotoxic. This is particularly C so with iron, selenium or cadmium; do not use for these metals. D Alkalinization of urine during therapy may have protective effects for E the kidney. F G Drug interactions: Iron salts should not be administered during H I therapy. J K DOSES L M Birds: 2.5 mg\/kg i.m. q4h for 2 days then q12h until signs resolve\u20061,2. N Mammals, Reptiles, Amphibians, Fish: No information available. O P References Q R 1\t De Francisco N, Ruiz Troya JD and Ag\u00fcera EI (2003) Lead and lead toxicity in domestic S and free living birds. Avian Pathology 32(1), 3\u201313 T U 2\t Richardson JA, Murphy LA, Khan SA and Means C (2001) Managing pet bird toxicoses. V Exotic DVM 3(1), 23\u201327 W X Dimethylsulfoxide (DMSO) Y Z (Rimso-50*) POM Formulations: Injectable: 50%, 90% liquid; medical grade only available as a 50% solution, other formulations are available as an industrial solvent. Topical: 70%, 90% gel; 70% cream. Action: The mechanism of action is not well understood. Antioxidant activity has been demonstrated in certain biological settings and is thought to account for the anti-inflammatory activity. Use: Management of otitis externa and haemorrhagic cystitis induced by cyclophosphamide. Although efficacy is unproven it has been used in the treatment of renal amyloidosis and prior to surgical treatment of pododermatitis (bumblefoot) in birds. In humans, DMSO is authorized for the treatment of interstitial cystitis. DMSO is very rapidly absorbed through the skin following administration by all routes and is distributed throughout the body. Metabolites of DMSO are excreted in the urine and faeces. DMSO is also excreted through the lungs and skin, producing a characteristic sulphuric odour. Humans given DMSO experience a garlic-like taste sensation after administration. Safety and handling: Should be kept in a tightly closed container because it is very hygroscopic. Gloves should be worn during topical application and the product should be handled with care. Contraindications: No information available. Adverse reactions: Adverse effects include local irritation and erythema caused by local histamine release. Intravenous administration of solutions with concentrations >20% may cause haemolysis and diuresis. Drug interactions: DMSO should not be mixed with other potentially toxic ingredients when applied to the skin because of profound enhancement of systemic absorption.","106 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A DOSES Birds: May be applied topically to lesions (e.g. bumblefoot) as an B anti-inflammatory prior to surgery. May be combined with other drugs as a carrying agent. C Mammals, Reptiles, Amphibians, Fish: No information available. D Dimilin see Diflubenzuron E F Dinoprost tromethamine G (Prostaglandin F2) H (Enzaprost, Lutalyse) POM-V I Formulations: Injectable: 5 mg\/ml solution. Action: Stimulates uterine contraction, causes cervical relaxation J and inhibits progesterone production by the corpus luteum. K Use: Used in the termination of pregnancy at any stage of gestation and to stimulate uterine contractions in the treatment of open L pyometra. Possesses prokinetic effects on the caecum of the rabbit. Safety and handling: Pregnant woman and asthmatics should M avoid handling this agent. N Contraindications: Do not use for the treatment of closed pyometra as there is a risk of uterine rupture. Do not use in birds if O the ureterovaginal sphincter is not dilated. P Adverse reactions: Hypersalivation, panting, tachycardia, vomiting, urination, defecation, transient hyperthermia, locomotor Q incoordination and mild CNS signs have been reported. Such effects usually diminish within 30 min of drug administration. There is no R adverse effect on future fertility. Severe adverse effects have been reported in birds. S Drug interactions: The effect of oxytocin would be potentiated by prostaglandins and inhibited by progestogens. T DOSES U Mammals: Rabbits: 0.2 mg\/kg single i.m. injection following 3 days of oral liquid paraffin to assist in emptying impacted caecal contents. V Birds: 0.02\u20130.1 mg\/kg i.m., intracloacal once. W Reptiles, Amphibians, Fish: No information available. X Y Z","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 107 Dinoprostone (Prostaglandin E2) A B (Prostin E2*) POM C D Formulations: Topical: 0.4 mg\/ml gel. E F Action: Stimulates uterine contraction, causes cervical relaxation G H and inhibits progesterone production by the corpus luteum. I J Use: Used to relax the vagina and induce uterine contractions in K L egg-bound birds. M N Safety and handling: Pregnant women and asthmatics should O P avoid handling this agent. Q R Contraindications: No information available. S T Adverse reactions: Uterine rupture may occur. U V Drug interactions: No information available. W X DOSES Y Z Birds: Apply a thin layer of gel to the cloacal mucosa once. Mammals, Reptiles, Amphibians, Fish: No information available. Diphenhydramine (Dreemon*, Nytol*) P Formulations: Oral: 25 mg tablet; 2 mg\/ml solution. Other products are available of various concentrations and most contain other active ingredients. Action: The antihistaminergic (H1) effects are used to reduce pruritus and prevent motion sickness. It is also a mild anxiolytic and sedative. Use: In birds it is used in the management of allergic rhinitis, hypersensitivity reactions and allergic dermatopathies. In ferrets it is used before vaccination if a previous vaccine reaction has been encountered, or for prevention of sneezing or coughing when these interrupt eating or sleeping. In rabbits it may also be used to reduce possible nausea associated with torticollis. Liquid is very distasteful. Safety and handling: Normal precautions should be observed. Contraindications: Urine retention, glaucoma and hyperthyroidism. Adverse reactions: No information available. Drug interactions: An increased sedative effect may occur if used with benzodiazepines or other anxiolytics\/hypnotics. Avoid the concomitant use of other sedative agents. Diphenhydramine may enhance the effect of adrenaline and partially counteract anticoagulant effects of heparin.","108 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A DOSES Mammals: Ferrets: 0.5\u20132 mg\/kg p.o., s.c. q8\u201312h for allergic B reactions; for preventative management of vaccination reactions, give the high end of the dose range by i.m. injection prior to C vaccination; Rabbits: 2 mg\/kg p.o., s.c., i.m. q12h for torticollis; Guinea pigs: 1\u20135 mg\/kg s.c. prn; Chinchillas, Hamsters, Rats, Mice: D 1\u20132 mg\/kg p.o., s.c. q12h; Primates: 5 mg\/kg\/day p.o., i.m. total dose divided q6\u20138h. E Birds: 2\u20134 mg\/kg p.o. q12h. Reptiles, Amphibians, Fish: No information available. F G Domperidone H (Domperidone*, Motilium*) POM I Formulations: Oral: 10 mg tablet, 1 mg\/ml suspension. J Action: A potent antiemetic with a similar mechanism of action to metoclopramide, but with fewer adverse CNS effects as it cannot K penetrate the blood\u2013brain barrier. It is gastrokinetic in humans and rabbits. L Use: Treatment of vomiting and reduced gastrointestinal motility. In M rabbits, it has a significant prokinetic action on gastric emptying. Safety and handling: Normal precautions should be observed. N Contraindications: Gastrointestinal obstruction or perforation. O Adverse reactions: No information available. P Drug interactions: No information available. DOSES Q Mammals: Rabbits: 0.5 mg\/kg p.o. q12h. R Birds, Reptiles, Amphibians, Fish: No information available. S Dopamine T (Dopamine*) POM U Formulations: Injectable: 200 mg in 5 ml vial (40 mg\/ml solution), V 800 mg in a 5 ml vial (160 mg\/ml solution). Action: Dopamine is an endogenous catecholamine and precursor W of noradrenaline, with direct and indirect (via release of noradrenaline) agonist effects on dopaminergic and beta-1 and X alpha-1 adrenergic receptors. Y Use: Improvement of haemodynamic status. Main indications are treatment of shock following correction of fluid deficiencies, acute Z heart failure, and support of blood pressure during anaesthesia. Dobutamine is preferred for support of systolic function in patients","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 109 with heart failure. Dopamine is a potent and short-acting drug, A therefore it should be given in low doses by continuous rate B infusion, and accurate dosing is important. Dopamine should be C diluted in normal saline to an appropriate concentration. At low D doses (<10 \u03bcg\/kg\/min) dopamine acts on dopaminergic and beta-1 E adrenergic receptors, causing vasodilation, increased force of F contraction and heart rate, and resulting in an increase in cardiac G output and organ perfusion; systemic vascular resistance remains H largely unchanged. At higher doses (>10 \u03bcg\/kg\/min) dopaminergic I effects are overridden by the alpha effects, resulting in an increase in J systemic vascular resistance and reduced peripheral blood flow. K Dopamine has been shown to vasodilate mesenteric blood vessels L via DA1 receptors. There may be an improvement in urine output but M this may be entirely due to inhibition of proximal tubule sodium ion N reabsorption and an improved cardiac output and blood pressure O rather than directly improving renal blood flow. The dose of P dopamine should be adjusted according to clinical effect, therefore Q monitoring of arterial blood pressure during administration is R advisable. All sympathomimetic drugs have pro-arrhythmic S properties, therefore ECG monitoring is advised. T U Safety and handling: Solution should be discarded if it becomes V W discoloured. X Y Contraindications: Discontinue or reduce the dose of dopamine Z should cardiac arrhythmias arise. Adverse reactions: Extravasation of dopamine causes necrosis and sloughing of surrounding tissue due to tissue ischaemia. Should extravasation occur, infiltrate the site with a solution of 5\u201310 mg phentolamine in 10\u201315 ml of normal saline using a syringe with a fine needle. Nausea, vomiting, tachyarrhythmias and changes in blood pressure are the most common adverse effects. Hypotension may develop with low doses, and hypertension may occur with high doses. Sudden increases in blood pressure may cause a severe bradycardia. All dopamine-induced arrhythmias are most effectively treated by stopping the infusion. Drug interactions: Risk of severe hypertension when monoamine oxidase inhibitors, doxapram and oxytocin are used with dopamine. Halothane may increase myocardial sensitivity to catecholamines. The effects of beta-blockers and dopamine are antagonistic. DOSES Mammals: Guinea pigs: 0.08 mg\/kg i.v. prn. Birds: 5\u201310 \u03bcg (micrograms)\/kg\/min to counter isoflurane-induced hypotension. More effective than dobutamine\u2006a. Reptiles, Amphibians, Fish: No information available. References a\t Schnellbacher RW, Da Cunha AF, Beaufr\u00e8re H et al. (2012) Effects of dopamine and dobutamine on isoflurane-induced hypotension in Hispaniolan Amazon parrots (Amazona ventralis). American Journal of Veterinary Research 73(7), 952\u2013958","110 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Dorzolamide (CoSopt*, Dorzolamide*, Dorzolamide with B Timolol*, Trusopt*) POM C Formulations: Ophthalmic drops: 20 mg\/ml (2%) (Dorzolamide, D Trusopt), 2% dorzolamide + 0.5% timolol (CoSopt, Dorzolamide with Timolol); 5 ml bottle, single-use vials (CoSopt, Trusopt). E Action: Reduces intraocular pressure by reducing the rate of F aqueous humour production by inhibiting the formation of bicarbonate ions within the ciliary body epithelium. G Use: In the control of all types of glaucoma, either alone or in combination with other topical drugs. It may be less tolerated than H brinzolamide because of its less physiological pH of 5.6. The concurrent use of a topical and a systemic carbonic anhydrase I inhibitor is not beneficial as there is no additional decrease in intraocular pressure compared with either route alone. J Safety and handling: Normal precautions should be observed. K Contraindications: Severe hepatic or renal impairment. L Dorzolamide\/timolol is not the drug of choice in uveitis or anterior lens luxation. M Adverse reactions: Local irritation and blepharitis. Dorzolamide may cause more local irritation than brinzolamide. Dorzolamide\/ N timolol causes miosis. O Drug interactions: No information available. DOSES P Mammals: Rabbits: 1 drop\/eye q8\u201312h; Rats: 1 drop 1% solution Q (dilute standard formulation with sterile water) q12h. Birds: 1 drop\/eye q12h\u20061,2. R Reptiles, Amphibians, Fish: No information available. References S 1\t Fordham M, Rosenthal K, Durham A, Duda L and Kom\u00e1romy AM (2010) Intraocular osteosarcoma in an Umbrella cockatoo (Cacatua alba). Veterinary Ophthalmology 13, T 103\u2013108 2\t Jayson S, Guzman DSM, Petritz O, Freeman K and Maggs DJ (2014) Medical management of acute ocular hypertension in a western screech owl (Megascops U kennicottii). Journal of Avian Medicine and Surgery 28(1), 38\u201345 V Doxapram W (Dopram-V, Doxapram hydrochloride) X POM-VPS, POM-V, POM Y Formulations: Injectable: 20 mg\/ml solution. Oral: 20 mg\/ml drops. Z Action: Stimulates respiration by increasing the sensitivity of aortic and carotid body chemoreceptors to arterial gas tensions.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 111 Use: Stimulates respiration during and after general anaesthesia. In A B neonatal animals, used to stimulate or initiate respiration after birth, C particularly in those delivered by caesarean section. The dose D should be adjusted according to the requirements of the situation; E adequate but not excessive doses should be used. A patent airway is F essential. Must not be used indiscriminately to support respiratory G function. Severe respiratory depression should be controlled by H tracheal intubation, followed by IPPV and then resolution of the I initiating cause. Duration of effect in mammals is 15\u201320 minutes. J Has also been used to aid assessment of laryngeal function under K light anaesthesia. Not effective at stimulating respiration in the face L of hypoxaemia (pre-oxygenation of hypoventilating neonates is M recommended, along with removal of obstructive secretions). Used N for the treatment of respiratory depression in fish. O P Safety and handling: Protect from light. Q R Contraindications: Do not use in animals without a patent S T airway. U V Adverse reactions: Overdose can cause excessive W X hyperventilation, which may be followed by reduced carbon dioxide Y tension in the blood leading to cerebral vasoconstriction. This could Z result in cerebral hypoxia in some animals. Doxapram is irritant and may cause a thrombophlebitis, avoid extravasation or repeated i.v. injection into the same vein. Use doxapram injection with caution in neonates because it contains benzyl alcohol which is toxic. Overdosage signs include hypertension, skeletal muscle hyperactivity, tachycardia and generalized CNS excitation including seizures; treatment is supportive using short-acting i.v. barbiturates or propofol and oxygen. Effects in pregnant\/lactating animals are not known. Drug interactions: Hypertension may occur with sympathomimetics. The use of theophylline concurrently with doxapram may cause increased CNS stimulation. As doxapram may stimulate the release of adrenaline, its use within 10 min of the administration of anaesthetic agents that sensitize the myocardium to catecholamines (e.g. halothane) should be avoided. Doxapram is compatible with 5% dextrose or normal saline, but is incompatible with sodium bicarbonate or thiopental. High doses administered during or after anaesthesia with halogenated hydrocarbon anaesthetics, such as halothane, may precipitate cardiac arrhythmias. Doxapram injection should be used with extreme caution in animals that have been sedated with morphine. Administration of doxapram at 10 mg\/kg to such animals may be followed by convulsions. DOSES Mammals: Ferrets, Rabbits, Chinchillas, Rats, Mice, Hamsters, Gerbils, Hedgehogs: 5\u201310 mg\/kg i.v., i.m., i.p., sublingual once; Guinea pigs: 2\u20135 mg\/kg i.v., s.c., i.p. once; Primates: 2 mg\/kg i.v.; Sugar gliders: 2 mg\/kg i.v. once. Birds: 5\u201320 mg\/kg i.m., i.v., intratracheal, intraosseous once\u20061.","112 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Reptiles: 4\u201312 mg\/kg i.m., i.v., p.o. once. Fish: 5 mg\/kg i.v., intracoelomic\u20062, topically to the gills. B Amphibians: No information available. C References1\t Lierz M and Korbel R (2012) Anesthesia and analgesia in birds. Journal of Exotic Pet Medicine 21(1), 44\u201358 D 2\t Hadfield C, Whitaker BR and Clayton LA (2007) Emergency and critical care of fish. Veterinary Clinics of North America: Exotic Animal Practice 10, 647\u2013675 E F Doxepin G (Sinepin*, Sinequan*, Zonalon*) POM Formulations: Oral: 25 mg, 50 mg capsules. H Action: Doxepin blocks noradrenaline and serotonin re-uptake in I the brain, resulting in antidepressive activity, while the H1 and H2 blockage result in antipruritic effects. Its metabolite, J desmethyldoxepin, is also psychoactive. K Use: Management of pruritus and psychogenic dermatoses where there is a component of anxiety, including compulsive disorders. L Data are lacking as to its efficacy at the suggested doses. Used in birds for organophosphate toxicity. When used in birds it is M important to monitor for cardiac arrhythmias. Safety and handling: Normal precautions should be observed. N Contraindications: Hypersensitivity to tricyclic antidepressants, O glaucoma, history of seizures or urinary retention and severe liver disease. P Adverse reactions: Sedation, dry mouth, diarrhoea, vomiting, Q excitability, arrhythmias, hypotension, syncope, increased appetite, weight gain and, less commonly, seizures and bone marrow R disorders have been reported in humans. Drug interactions: Should not be used with monoamine oxidase S inhibitors or drugs which are metabolized by cytochrome P450 2D6, e.g. chlorphenamine and cimetidine. T DOSES U Birds: Feather plucking: 1\u20132 mg\/kg p.o. q12h\u20061; organophosphate toxicity: 0.2 mg\/kg i.m. q4h. V Mammals, Reptiles, Amphibians, Fish: No information available. W References1\t van Zeeland YRA, Spruit BM, Rodenburg TA et al. (2009) Feather damaging behaviour in parrots: a review with consideration of comparative aspects. Applied Animal X Behaviour Science 121(2), 75\u201395 Y Z","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 113 Doxorubicin (Adriamycin) A B (Doxorubicin*) POM C D Formulations: Injectable: 10 mg, 50 mg powders for E F reconstitution; 10 mg, 50 mg\/vial solutions. G H Action: Inhibits DNA synthesis and function. I J Use: Treatment of lymphoma in the ferret. Has been used to treat K L lymphoma in a green iguana. It may be used alone or in M combination with other antineoplastic therapies. Premedication with N i.v. chlorphenamine or dexamethasone is recommended. O Doxorubicin is highly irritant and must be administered via a P preplaced i.v. catheter. The reconstituted drug should be Q administered over a minimum period of 10 min into the side port of R a freely running i.v. infusion of 0.9% NaCl. Do not use heparin flush. S May need to reduce dose in patients with liver disease. Use with T caution in patients previously treated with radiation as can cause U radiation recall. V W Safety and handling: Potent cytotoxic drug that should only be X Y prepared and administered by trained personnel. See specialist Z texts for further advice on chemotherapeutic agents. After reconstitution the drug is stable for at least 48h at 4\u00b0C. A 1.5% loss of potency may occur after 1 month at 4\u00b0C but there is no loss of potency when frozen at \u201320\u00b0C. Filtering through a 0.22 \u03bcm filter will ensure adequate sterility of the thawed solution. Store unopened vials under refrigeration. Contraindications: Do not use in patients with existing cardiac or renal disease. Adverse reactions: Allergic reactions have been reported; acute anaphylactic reactions should be treated with adrenaline, steroids and fluids. Doxorubicin causes a dose-dependent cumulative cardiotoxicity in dogs (leading to cardiomyopathy and congestive heart failure), and this may be of concern in ferrets. The risk of cardiotoxicity is greatly increased when the cumulative dose is >240 mg\/m2. It may also cause tachycardia and arrhythmias on administration; monitor with ECG and\/or echocardiograms. Anorexia, vomiting, severe leucopenia, thrombocytopenia, haemorrhagic gastroenteritis and nephrotoxicity are the major adverse effects. A CBC and platelet count should be monitored whenever therapy is given. If the neutrophil count drops below 3 \u00d7 109\/l or the platelet count drops below 50 \u00d7 109\/l, treatment should be suspended. Once the counts have stabilized, doxorubicin can be restarted at the same dose. If haematological toxicity occurs again, or if GI toxicity is recurrent, the dose should be reduced by 10\u201325%. Extravasation injuries secondary to perivascular administration may be serious, with severe tissue ulceration and necrosis possible. Dexrazoxane can be used to treat extravasation if it occurs. Ice compresses may also be beneficial (applied for 15 min q6h).","114 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Drug interactions: Barbiturates increase plasma clearance of doxorubicin. The agent causes a reduction in serum digoxin levels. B Do not mix doxorubicin with other drugs. Doxorubicin is incompatible with dexamethasone, 5-fluorouracil and heparin; C concurrent use will lead to precipitate formation. DOSES D See Appendix for chemotherapy protocols in ferrets. E Mammals: Ferrets: 20 mg\/m2 or 1\u20132 mg\/kg i.v. every 3 weeks for a maximum of 5 doses. Also used as part of a multi-drug protocol for F lymphoma. Birds: 2 mg\/kg i.v. infused in normal saline over 20 minutes\u2006a. G Reptiles: 0.26\u20130.75 mg\/kg i.v. reported as part of a successful chemotherapy protocol in a green iguana\u20061. H Amphibians, Fish: No information available. I Referencesa\t Gilbert CM, Filippich LJ and Charles BG (2004) Doxorubicin pharmacokinetics following a single-dose infusion to sulphur-crested cockatoos (Cacatua galerita). J Australian Veterinary Journal 82(12), 769\u2013772 1\t Folland DW, Johnston MS, Thamm DH and Reavill D (2011) Diagnosis and K management of lymphoma in a green iguana (Iguana iguana). Journal of the American Veterinary Medical Association 239(7), 985\u2013991 L Doxycycline M (Doxyseptin 300, Karidox, Ornicure, Pulmodox, N Ronaxan, Vibramycin*, Vibravenos*) POM-V O Formulations: Oral: 20 mg, 100 mg tablets (Ronaxan), 300 mg tablets (Doxyseptin); 260 mg\/sachet powder (Ornicure); 100 mg\/ml P oral solution (Karidox). Injectable: 20 mg\/ml long-acting injection Q (Vibravenos; import on an STC). Action: Bacteriostatic agent inhibiting protein synthesis at the R initiation step by interacting with the 30S ribosomal subunit. S Use: Antibacterial (including spirochaetes such as Helicobacter and Campylobacter), antirickettsial, antimycoplasmal and T antichlamydial activity. It is the drug of choice to treat avian chlamydiosis; treatment may be required for 6 weeks in birds. It is U not affected by, and does not affect, renal function as it is excreted in faeces, and is therefore recommended when tetracyclines are V indicated in animals with renal impairment. It is preferred by some authors to oxytetracycline for use in birds. Being extremely W lipid-soluble, it penetrates well into prostatic fluid and bronchial secretions. Administer with food. Injection is very irritant in birds: X must alternate injection sites or divide dose if large volume to inject. Y Safety and handling: Normal precautions should be observed. Z Contraindications: Do not administer to pregnant animals. Do not administer if there is evidence of oesophagitis or dysphagia.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 115 Adverse reactions: Nausea, vomiting and diarrhoea. A B Oesophagitis and oesophageal ulceration may develop; administer C with food or a water bolus to reduce this risk. Administration during D tooth development may lead to discoloration of the teeth, although E the risk is less than with other tetracyclines. F G Drug interactions: Absorption of doxycycline is reduced by H I antacids, calcium, magnesium and iron salts, although the effect is J less marked than that seen with water-soluble tetracyclines. K Phenobarbital and phenytoin may increase its metabolism, thus L decreasing plasma levels. Do not use in combination with M bactericidal antimicrobials. N O DOSES P Q See Appendix for guidelines on responsible antibacterial use. R Mammals: Rabbits: 2.5\u20134 mg\/kg p.o. q24h; Rats, Mice: 5 mg\/kg S p.o. q12h; Other rodents: 2.5 mg\/kg p.o. q12h or 70\u2013100 mg\/kg s.c., T i.m. of the long-acting preparation (Vibravenos); Primates: 3\u20134 mg\/ U kg p.o. q12h; Hedgehogs: 2.5\u201310 mg\/kg p.o., s.c., i.m. q12h. V Birds: Raptors: 50 mg\/kg p.o. q12h, 100 mg\/kg i.m. q7d W (Vibravenos); Parrots: 15\u201350 mg\/kg p.o. q24h, 1000 mg\/kg in soft X food\/dehulled seed, 75\u2013100 mg\/kg i.m. q7d (Vibravenos; lowest Y dose rate for macaws)\u2006a,b,c,d; course of treatment with doxycycline for Z chlamydiosis = 45 days; Passerines\/Pigeons: 40 mg\/kg p.o. q12\u201324h, 200\u2013500 mg\/l in water (soft or deionized water only). Reptiles: 50 mg\/kg i.m. once, then 25 mg\/kg i.m. q72h. Amphibians: 50 mg\/kg i.m. q7d. Fish: No information available. References a\t Flammer K and Papich M (2005) Assessment of plasma concentrations and effects of injectable doxycycline in three psittacine species. Journal of Avian Medicine and Surgery 19(3), 216\u2013224 b\t Flammer K and Whitt-Smith D (2001) Plasma concentrations of doxycycline in selected psittacine birds when administered in water for potential treatment of Chlamydophila psittaci infection. Journal of Avian Medicine and Surgery 15(4), 276\u2013282 c\t Powers LV, Flammer K and Papich M (2000) Preliminary investigation of doxycycline plasma concentrations in Cockatiels (Nymphicus hollandicus) after administration by injection or in water or feed. Journal of Avian Medicine and Surgery 14(1), 23\u201330 d\t Saturation T (2008) Administration of doxycycline in drinking water for treatment of spiral bacterial infection in Cockatiels. Journal of Zoo and Wildlife Medicine 39(3), 499\u2013501","116 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Edetate calcium disodium (CaEDTA) B (Ledclair*) POM Formulations: Injectable: 200 mg\/ml solution. C Action: Heavy metal chelating agent. D Use: Lead and zinc poisoning. Dilute strong solution to a concentration of 10 mg\/ml in 5% dextrose before use. Blood lead E levels may be confusing, therefore monitor clinical signs during F therapy. Measure blood lead levels 2\u20133 weeks after completion of treatment in order to determine whether a second course is required G or if the animal is still being exposed to lead. Ensure there is no lead in the GI tract before administering (e.g. use laxatives) nor any H residual heavy metals elsewhere (e.g. powdered zinc in coat or an environmental source). I Safety and handling: Normal precautions should be observed. J Contraindications: Use with caution in patients with impaired renal function. K Adverse reactions: Reversible nephrotoxicity is usually preceded by other clinical signs of toxicity (e.g. depression, vomiting, L diarrhoea). Injections are painful. M Drug interactions: No information available. DOSES N Mammals: Ferrets: 20\u201330 mg\/kg s.c. q12h; Rabbits: 27.5 mg\/kg s.c. O q6h; Rodents: 25\u201330 mg\/kg s.c. q6\u201312h. Repeat treatment for 5 days on, 5 days off until blood lead or zinc levels are normal when P measured at the end of the period off treatment. Birds: 35\u201350 mg\/kg i.m., s.c. q12h for 5 days followed by 2 days of Q no treatment, then repeat until metal particles are no longer visible on radiographs\u2006a. 100 mg\/kg i.m. weekly has been proposed in zinc R toxicosis. Reptiles: 10\u201340 mg\/kg i.m. q12h. S Amphibians, Fish: No information available. T Referencesa\t Sears J, Cooke SW, Cooke ZR and Heron TJ (1989) A method for the treatment of lead poisoning in the mute swan (Cygnus olor) and its long-term success. British Veterinary U Journal 145(6), 586\u2013595 V Emamectin benzoate W (Lice-Solve, Slice) ESPA, POM-V X Formulations: Immersion: 10 g, 100 g sachets of powder containing 1.4% emamectin. In food: 2.5 kg pouch of powder Y containing 5 g emamectin benzoate. Z Action: Irreversibly binds to and opens GABA and glutamate-gated channels, leading to flaccid paralysis and death of the parasite.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 117 Use: Treatment of crustacean parasites of fish (Argulus, Ergasilus A B spp.). For use in closed water systems. Turn off UV and carbon filters C for 24 h after adding the product to the water. Ensure good aeration D of the water during treatment. Emamectin rapidly biodegrades in E sunlight. F G Safety and handling: Normal precautions should be observed. H I Do not dispose of down drains or in waterways. J K Contraindications: Do not use at the same time as other fish or L M pond treatments. Do not use in ponds containing orfe (Leuciscus N spp.) or terrapins. O P Adverse reactions: No information available. Q R Drug interactions: No information available. S T DOSES U V Fish: 56 \u03bcg (micrograms)\/l by prolonged immersion, repeat after 1 W month. Goldfish: 0.05 mg\/kg bodyweight daily in food for 7 days; X Koi: 0.005 mg\/kg bodyweight daily in food for 7 days\u2006a. Y Mammals, Birds, Reptiles, Amphibians: No information Z available. References a\t Hanson SK, Hill JE, Watson CA, Yanong RP and Endris R (2011) Evaluation of emamectin benzoate for the control of experimentally induced infestations of Argulus sp. in goldfish and koi carp. Journal of Aquatic Animal Health 23(1), 30\u201334 Emodepside (Profender) POM-V Formulations: Topical: 21.4 mg\/ml emodepside with praziquantel solution in spot-on pipettes. Action: Stimulates presynaptic secretin receptors resulting in paralysis and death of the parasite. Use: Treatment of roundworms (adult and immature) and tapeworms (adult) including Toxocara cati, Toxascaris leonina, Ancylostoma tubaeforme, Aelurostrongylus abstrusus, Dipylidium caninum, Taenia taeniaeformis, Echinococcus multilocularis. Do not shampoo until substance has dried. Treatment of a variety of reptile endoparasites including oxyurids, ascarids, strongylids, trichostrongylids and capillarids. Safety and handling: Women of child-bearing age should avoid contact with this drug or wear disposable gloves when using it. Contraindications: Do not use in pregnant mammals. Studies in rabbits and rats suggest it may interfere with fetal development in utero. Adverse reactions: Ingestion may result in salivation or vomiting. Harmful to aquatic animals.","118 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Drug interactions: Possible interaction with P-glycoprotein substrates\/inhibitors. B DOSES C Mammals: Rabbits: 0.14 ml\/kg topically once (reported for Trichostrongylus colubriformis). D Reptiles: <1.12 ml\/kg Profender applied topically once (corresponding to 24 mg emodepside and 96 mg praziquantel\/kg)\u2006a,b. E Birds, Amphibians, Fish: No information available. References F a\t Schilliger L, Betremieux O, Rochet J, Krebber R and Schaper R (2009) Absorption and efficacy of a spot-on combination containing emodepside plus praziquantel in G reptiles. Revue de M\u00e9decine V\u00e9t\u00e9rinaire 160(12), 557\u2013561 b\t Tang PK, Pellett S, Blake D and Hedley J (2017) Efficacy of a Topical Formulation Containing Emodepside and Praziquantel (Profender\u00ae, Bayer) against Nematodes in H Captive Tortoises. Journal of Herpetological Medicine and Surgery 27(3), 116\u2013122 I Enalapril J (Enacard) POM-V K Formulations: Oral: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg tablets. L Action: Angiotensin converting enzyme (ACE) inhibitor. It inhibits conversion of angiotensin I to angiotensin II and inhibits the M breakdown of bradykinin. Overall effect is a reduction in preload and afterload via venodilation and arteriodilation, decreased salt and N water retention via reduced aldosterone production and inhibition of the angiotensin-aldosterone-mediated cardiac and vascular O remodelling. Efferent arteriolar dilation in the kidney can reduce intraglomerular pressure and therefore glomerular filtration. This P may decrease proteinuria. Q Use: Treatment of congestive heart failure caused by mitral regurgitation or dilated cardiomyopathy. Often used in conjunction R with diuretics when heart failure is present as most effective when used in these cases. Can be used in combination with other drugs to S treat heart failure (e.g. pimobendan, spironolactone, digoxin). May be beneficial in cases of chronic renal insufficiency, particularly T protein-losing nephropathies. May reduce blood pressure in hypertension. ACE inhibitors are more likely to cause or exacerbate U prerenal azotaemia in hypotensive animals and those with poor renal perfusion (e.g. acute, oliguric renal failure). Use cautiously if V hypotension, hyponatraemia or outflow tract obstruction are present. Regular monitoring of blood pressure, serum creatinine, W urea and electrolytes is strongly recommended with ACE inhibitor treatment. Hypotension, azotaemia and hyperkalaemia are all X indications to stop or reduce ACE inhibitor treatment in rabbits. Safety and handling: Normal precautions should be observed. Y Contraindications: Do not use in cases of cardiac output failure. Z","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 119 Adverse reactions: Potential adverse effects include hypotension, A B hyperkalaemia and azotaemia. Monitor blood pressure, serum C creatinine and electrolytes when used in cases of heart failure. D Dosage should be reduced if there are signs of hypotension E (weakness, disorientation). Anorexia, vomiting and diarrhoea are F rare. It is not recommended for breeding, pregnant or lactating G animals, as safety has not been established. In rabbits, treatment H with ACE inhibitors can be associated with an increase in azotaemia I and significant hypotension; treatment should start at the lower end J of the range. K L Drug interactions: Concomitant treatment with potassium- M N sparing diuretics (e.g. spironolactone) or potassium supplements O could result in hyperkalaemia. However, in practice, spironolactone P and ACE inhibitors appear safe to use concurrently. There may be an Q increased risk of nephrotoxicity and decreased clinical efficacy when R used with NSAIDs. There is a risk of hypotension with concomitant S administration of diuretics, vasodilators (e.g. anaesthetic agents, T antihypertensive agents) or negative inotropes (e.g. beta-blockers). U V DOSES W X Mammals: Ferrets: 0.25\u20130.5 mg\/kg p.o. q24\u201348h; Rabbits: Y 0.25\u20130.5 mg\/kg p.o. q24\u201348h; Rodents: 0.5\u20131.0 mg\/kg p.o. q24h; Z Primates: 0.3 mg\/kg p.o. q24h; Common marmosets: 0.5 mg\/kg p.o. q48h; Sugar gliders, Hedgehogs: 0.5 mg\/kg p.o. q24h. Birds: 1.25 mg\/kg p.o. q12h\u20061. Reptiles, Amphibians, Fish: No information available. References 1\t Fitzgerald BC, Dias S and Martorell J (2018) Cardiovascular Drugs in Avian, Small Mammal, and Reptile Medicine. Veterinary Clinics: Exotic Animal Practice 21(2), 399\u2013442 Enilconazole (Imaverol) POM-VPS Formulations: Topical: 100 mg\/ml (10%) liquid. Action: Inhibition of cytochrome P450-dependent synthesis of ergosterol in fungal cells, causing increased cell wall permeability and allowing leakage of cellular contents. Use: Fungal infections of the skin and nasal aspergillosis. Has been shown to inhibit zoospores of Batrachochytrium dendrobatidis in vitro but there is no information on systemic clinical treatment of amphibians with chytridiomycosis. Safety and handling: Normal precautions should be observed. Contraindications: No information available. Adverse reactions: Hepatotoxic if swallowed. Avoid contact with eyes. Drug interactions: No information available.","120 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A DOSES Mammals: Rabbits: Dilute 1:50 in water to produce a 2 mg\/ml B (0.2%) solution. Apply topically to lesions every 1\u20133 days for 3\u20134 applications and then check success of therapy with fungal culture; C Hamsters: 0.2% rinse topically every 7 days until fungal cultures negative. D Birds: Dilute 1:10 in water and give 0.5 ml\/kg\/day intratracheally for 7\u201314 days\u2006a. E Reptiles: Dilute 1:50 in water. Apply topically to lesions every 2\u20133 F days. Amphibians, Fish: No information available. G References a\t Perelman B, Smith B, Bronstein D, Gur-Lavie A and Kuttin ES (1992) Use of azole H compounds for the treatment of experimental aspergillosis in turkeys. Avian Pathology 21(4), 591\u2013599 I J Enrofloxacin (Baytril, Enrobactin, Enrocare, Enrotab, K Enrotron, Enrox, Enroxil, Floxabactin, Floxibac, L Powerflox, Quinoflox, Xeden, Zobuxa) POM-V M Formulations: Injectable: 25 mg\/ml, 50 mg\/ml, 100 mg\/ml solutions. Oral: 15 mg, 50 mg, 150 mg, 250 mg tablets; 25 mg\/ml N solution. O Action: Enrofloxacin is a bactericidal antimicrobial which inhibits bacterial DNA gyrase. The bactericidal action is concentration- P dependent, meaning that pulse-dosing regimens may be effective, particularly against Gram-negative bacteria. Q Use: Ideally fluoroquinolone use should be reserved for infections R where culture and sensitivity testing predicts a clinical response and where first- and second-line antimicrobials would not be effective. S Active against Mycoplasma and many Gram-positive and Gram- negative organisms, including\u00a0Pasteurella, Staphylococcus, T Pseudomonas aeruginosa, Klebsiella, Escherichia coli, Mycobacterium, Proteus\u00a0and Salmonella. Relatively ineffective U against obligate anaerobes. Fluoroquinolones are highly lipophilic drugs that attain high concentrations within cells in many tissues V and are particularly effective in the management of soft tissue, urogenital (including prostatic) and skin infections. For the treatment W of non-tubercular mycobacterial disease, enrofloxacin can be combined with clarithromycin and rifampin. Administration by i.v. X route is not authorized but has been used in cases of severe sepsis. If this route is used, administer slowly as the carrier contains Y potassium. Dilute solution for injection 1 in 4 with water if dosing small mammals orally. Switch to oral medications in birds as soon as Z possible. Used for the treatment of bacterial disease in fish, particularly those caused by Gram-negative organisms.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 121 Safety and handling: Normal precautions should be observed. A B Contraindications: Fluoroquinolones are relatively C D contraindicated in growing small mammals as cartilage E abnormalities have been reported in young mice, rats, guinea pigs F and rabbits after administration of fluoroquinolones similar to G enrofloxacin. H I Adverse reactions: In birds, joint lesions have been induced in J K nestling pigeons with high doses of enrofloxacin, and in all species, L muscle necrosis may be seen following i.m. administration. M Enrofloxacin should be used with caution in epileptics until further N information is available, as in humans they potentiate CNS adverse O effects when administered concurrently with NSAIDs. Excitation and P diarrhoea have been reported in Galapagos tortoises. Q R Drug interactions: Adsorbents and antacids containing cations S T (Mg2+, Al3+) may bind to fluoroquinolones and prevent their U absorption from the GI tract. The absorption of fluoroquinolones V may also be inhibited by sucralfate and zinc salts; separate doses of W these drugs by at least 2 hours. Fluoroquinolones increase plasma X theophylline concentrations. Cimetidine may reduce the clearance Y of fluoroquinolones and so should be used with caution in Z combination with these drugs. Efficacy may be reduced due to chelation when used as a bath treatment for fish in hard water with high levels of divalent metal cations (Ca2+, Mg2+). DOSES See Appendix for guidelines on responsible antibacterial use. Mammals: Ferrets: 5\u201310 mg\/kg p.o., s.c., i.m. q12h or 10\u201320 mg\/kg p.o., s.c., i.m. q24h; Rabbits: 10\u201320 mg\/kg p.o., s.c., i.v. q24h; Rodents: 5\u201320 mg\/kg s.c., p.o. q12\u201324h; Primates: 5 mg\/kg p.o., s.c. q12\u201324h; Sugar gliders: 5 mg\/kg p.o., s.c., i.m. q12h; Hedgehogs: 2.5\u201310 mg\/kg p.o., s.c., i.m. q12h; Others: 5\u201310 mg\/kg s.c., p.o. q12h or 20 mg\/kg s.c., p.o. q24h. Birds: 10 mg\/kg p.o., i.m. q12h (licensed dose) or 100\u2013200 mg\/l drinking water\u2006a. Reptiles: Variable absorption when given p.o. so i.m. administration may be more appropriate in critically ill animals. Most species: 5\u201310 mg\/kg i.m., p.o. q24\u201348h; Indian star tortoises: 5 mg\/kg i.m. q12\u201324h\u2006b; Gopher tortoises: 5 mg\/kg i.m. q24\u201348h; Hermann\u2019s tortoises: 10 mg\/kg intracoelomic; Red-eared sliders: 5 mg\/kg i.m. or 10 mg\/kg p.o., i.m., s.c., intracoelomic q24h or 500 mg\/l as a 6\u20138 h bath q24h\u2006c; Savannah monitors: 10 mg\/kg i.m. q5d; Green iguanas: 5 mg\/kg p.o., i.m. q24h; Bearded dragons: 10 mg\/kg i.m.\u2006d Burmese pythons: 10 mg\/kg i.m., then q48h; Pit vipers: 10 mg\/kg i.m. q48\u201372h. South American Rattlesnakes: 10 mg\/kg i.m. Amphibians: 5\u201310 mg\/kg p.o., s.c., i.m. topical application q24h\u2006e. Fish: 5\u201310 mg\/kg i.m., intracoelomic, p.o. q24\u201348h for 7 doses or 2.5\u20135 mg\/l by immersion for 5 h q24\u201348h for 5\u20137 treatments\u2006f. References a\t Flammer K, Aucoin DP and Whitt DA (1991) Intramuscular and oral disposition of enrofloxacin in African grey parrots following single and multiple doses. Journal of Veterinary Pharmacology and Therapeutics 14(4), 359\u2013366","122 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A b\t Raphael BL, Papich M and Cook RA (1994) Pharmacokinetics of enrofloxacin after a single intramuscular injection in Indian star tortoises (Geochelone elegans). Journal of Zoo and Wildlife Medicine 25, 88\u201394 B c\t James SB, Calle PP, Raphael BL et al. (2003) Comparison of injectable versus oral enrofloxacin pharmacokinetics in red-eared slider turtles (Trachemys scripta elegans). Journal of Herpetological Medicine and Surgery 13(1), 5\u201310 C d\t Salvadori M, Vercelli C, De Vito V et al. (2017) Pharmacokinetic and pharmacodynamic evaluations of a 10 mg\/kg enrofloxacin intramuscular administration in bearded dragons (Pogona vitticeps): a preliminary assessment. Journal of Veterinary D Pharmacology and Therapeutics 40(1), 62\u201369 e\t Howard AM, Papich MG, Felt SA et al. (2010) The pharmacokinetics of enrofloxacin in E adult African clawed frogs (Xenopus laevis). Journal of the American Association for Laboratory Animal Science 49(6), 800\u2013804 f\t Lewbart G, Vaden S, Deen J et al. (1997) Pharmacokinetics of enrofloxacin in the red F pacu (Colossoma brachypomum) after intramuscular, oral and bath administration. Journal of Veterinary Pharmacology and Therapeutics 20, 124\u2013128 G Epinephrine see Adrenaline Epoetin alfa, Epoetin beta see Erythropoietin H I Equine chorionic gonadotrophin see Serum J gonadotrophin K Erythromycin L (Erythrocin, Erythromycin*, Erythroped*) POM-V, M POM N Formulations: Injectable: 200 mg\/ml solution; 1 g\/vial powder for reconstitution. Oral: 250 mg, 500 mg tablets\/capsules; 25 mg\/ml O suspension; powder authorized for chickens. Action: May be bactericidal (time-dependent) or bacteriostatic, P depending upon drug concentration and bacterial susceptibility. It binds to the 50S ribosome, inhibiting peptide bond formation. Q Use: Has a similar antibacterial spectrum to penicillins. It is active R against Gram-positive cocci (some Staphylococcus species are resistant), Gram-positive bacilli and some Gram-negative bacilli S (Pasteurella). Some strains of Actinomyces, Nocardia, Chlamydia\u00a0 and Rickettsia are also inhibited by erythromycin. Most of the T Enterobacteriaceae (Pseudomonas, Escherichia coli, Klebsiella) are resistant. It is used in hamsters to treat proliferative ileitis (Lawsonia U intracellularis) and in ferrets to control Campylobacter infection, although it may not eliminate intestinal carriage of this organism. V Being a lipophilic weak base, it is concentrated in fluids that are more acidic than plasma, including milk, prostatic fluid and W intracellular fluid. Resistance to erythromycin can be quite high, particularly in staphylococcal organisms. Erythromycin acts as a GI X prokinetic by stimulating motilin receptors. Different esters of erythromycin are available. It is likely that the kinetics and possibly Y the toxicity will differ, depending on the ester used. Erythromycin\u2019s activity is enhanced in an alkaline pH. As the base is acid-labile it Z should be administered on an empty stomach. Used for the treatment of bacterial diseases in fish where practical.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 123 Safety and handling: Normal precautions should be observed. A B Contraindications: In humans the erythromycin estolate salt has C D been implicated in causing cholestatic hepatitis. Although not E demonstrated in veterinary medicine, this salt should be avoided in F animals with hepatic dysfunction. Avoid oral administration in small G herbivores (e.g. rabbits). H I Adverse reactions: Care should be taken in cases of hepatic or J K renal impairment. Avoid oral administration in small herbivores (e.g. L rabbits), as can cause fatal enterotoxaemia. Its use as a prokinetic in M these species is not advised. Use as a immersion treatment for fish N may be harmful to biological filtration systems and is not advised. O P Drug interactions: Erythromycin may enhance the absorption of Q R digoxin from the GI tract and increase serum levels of cisapride, S methylprednisolone, theophylline and terfenadine. The interactions T with cisapride and terfenadine proved particularly significant in U human medicine, leading to fatal or near-fatal arrhythmias in some V patients receiving both drugs. Erythromycin should not be used in W combination with other macrolide, lincosamide or chloramphenicol X antimicrobials as antagonism may occur. Y Z DOSES See Appendix for guidelines on responsible antibacterial use. Mammals: Ferrets: 10 mg\/kg p.o. q6h; Hamsters, Rats, Mice: 20 mg\/kg p.o. q12h or 0.13 mg\/ml drinking water; Primates: 75 mg\/kg p.o. q12h; Hedgehogs: 10 mg\/kg p.o., i.m. q12h. Birds: 20 mg\/kg i.m., s.c. q8h; 60 mg\/kg p.o. q12h or 125 mg\/l of drinking water; 200 mg\/kg soft feed. Fish: 10\u201320 mg\/kg i.m. q24h for 1\u20133 treatments or 100\u2013200 mg\/kg p.o. q24h for 7\u201321 days. Reptiles, Amphibians: No information available. Erythropoietin (Epoetin alfa, Epoetin beta) (Eprex*, Neorecormon*) POM Formulations: Injectable: 1000 IU, 2000 IU, 5000 IU powders for reconstitution; 2000 IU\/ml, 4000 IU\/ml, 10,000 IU\/ml, 40,000 IU\/ml solutions. Eprex is epoetin alfa. Neorecormon is epoetin beta. Action: Stimulates division and differentiation of red blood cells. Use: Recombinant human erythropoietin (r-HuEPO) is predominantly used to treat anaemia associated with chronic renal failure, although it is also used to treat anaemic human patients with cancer and rheumatoid arthritis. Erythropoietin is not indicated in conditions where high serum concentrations of the hormone already exist (e.g. haemolytic anaemia, anaemia due to blood loss), where the anaemia is due to iron deficiency or where systemic","124 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A hypertension is present. Monitoring and\/or supplementation of iron may be necessary, especially if response to treatment is poor. B Darbepoetin may be a better choice in many cases. Safety and handling: Normal precautions should be observed. C Contraindications: Conditions where high serum concentrations D of erythropoietin already exist. Adverse reactions: Local and systemic allergic reactions may E rarely develop (skin rash at the injection site, pyrexia, arthralgia and F mucocutaneous ulcers). Drug interactions: No information available. G DOSES H Mammals: Ferrets, Rabbits: epoetin alfa: 50\u2013150 IU\/kg i.m., s.c. q48\u201372h; Primates: 50\u2013100 IU\/kg s.c., i.v. 3 times a week. Once I desired PCV reached, administer q7d for at least 4 weeks for maintenance. J Birds, Reptiles, Amphibians, Fish: No information available. K Ethylene glycol monophenyl ether see L Phenoxyethanol M N Eugenol (Isoeugenol, Oil of clove) O (Koi calm) ESPA Formulations: Immersion: Oil for dissolution in water. P Action: Produces anaesthesia by impeding peripheral nerve signal Q transmission to the CNS. R Use: For the sedation, immobilization, anaesthesia and euthanasia of fish. Ideally, the drug should be used in water from the tank or S pond of origin to minimize problems due to changes in water chemistry. Over-the-counter preparations contain about 1 g T eugenol per ml but are poorly soluble in water and must be made into a stock solution (e.g. 1:10 with 95% ethanol produces 100 mg\/ U ml) for more accurate dosing. The anaesthetic solution should be used on the day of preparation and be well aerated during use. Food V should be withheld from fish for 12\u201324 h before anaesthesia to reduce the risk of regurgitation. The stage of anaesthesia reached is W determined by the concentration used and the duration of exposure since absorption continues throughout the period of immersion. X Different species vary in their response and may require different concentrations. It is recommended to use the lower dose rates to Y test the selected drug concentration and exposure time with a small group before medicating large numbers. Fish may retain some Z movement during anaesthesia, making it less desirable to use during surgery. Anaesthetized fish should be returned to clean water from","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 125 their normal environment to allow recovery. For euthanasia, use A 5\u201310 times the normal anaesthetic dose and keep the fish in the B solution for at least 60 minutes after respiration ceases. C D Safety and handling: Normal precautions should be observed. E F Contraindications: No information available. G H Adverse reactions: Cardiorespiratory depression and death have I J been noted in some tropical marine fish (e.g. tangs, surgeonfish). K L Drug interactions: No information available. M N DOSES O P Amphibians: Leopard frogs: 255 mg\/l results in variable degree of Q sedation\u2006a; African clawed frogs: 350 mg\/l resulted in anaesthesia R after 5\u201310 minutes immersion\u2006b; Tiger salmanders: 450 mg\/l S resulted in anaesthesia in ~10 minutes in 80% of animals\u2006c. T Fish: Anaesthesia: 40\u2013120 mg\/l by immersion; Euthanasia: U 500\u20131000 mg\/ml by immersion or undiluted 10 drops\/l (whisk to V thoroughly mix with water) by immersion\u20061. Follow manufacturer\u2019s W recommendations for proprietary formulations. X Mammals, Birds, Reptiles: No information available. Y Z References a\t Lafortune M, Mitchell MA and Smith JA (2001) Evaluation of Medetomidine, Clove Oil and Propofol for Anesthesia of Leopard Frogs, Rana pipiens.\u00a0Journal of Herpetological Medicine and Surgery 11(4), 13\u201318 b\t Gu\u00e9nette SA, H\u00e9lie P, Beaudry F and Vachon P (2007) Eugenol for anesthesia of African clawed frogs (Xenopus laevis). Veterinary Anaesthesia and Analgesia\u00a034(3), 164\u2013170 c\t Mitchell MA, Riggs SM, Singleton CB, Diaz-Figueroa O and Hale LK (2009) Evaluating the clinical and cardiopulmonary effects of clove oil and propofol in tiger salamanders (Ambystoma tigrinum). Journal of Exotic Pet Medicine 18(1), 50\u201356 1\t Sneddon LU (2012) Clinical anaesthesia and analgesia in fish.\u00a0Journal of Exotic Pet Medicine 21, 32\u201343","126 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Famciclovir B (Famvir*) POM C Formulations: Oral: 125 mg, 250 mg tablet. Action: Inhibits viral replication (viral DNA polymerase); depends D on viral thymidine kinase for phosphorylation. E Use: Famciclovir is a pro-drug for penciclovir, which is closely related to aciclovir. Famciclovir is virostatic and is unable to eradicate F latent viral infection. Has been used experimentally in ducks to control hepatitis B virus infection. G Safety and handling: Normal precautions should be observed. H Contraindications: No information available. Adverse reactions: Little information available. A dose of 90 mg\/ I kg caused no changes in liver enzymes (single dose) but adversely J affected the conjunctival goblet cell density and therefore the quality of the tear film in cats. K Drug interactions: No information available. L DOSES Birds: Ducklings: 10 mg\/kg p.o. q24h\u2006a. M Reptiles: 10\u201330 mg\/kg p.o. q24h used to manage ranavirus outbreak in Eastern box turtles\u2006b. N Mammals, Amphibians, Fish: No information available. O Referencesa\t Lin E, Luscombe C, Colledge D, Wang YY and Locarnini S (1998) Long-term therapy with the guanine nucleoside analog penciclovir controls chronic duck hepatitis B virus P infection in vivo. Antimicrobial Agents and Chemotherapy 42(8), 2132\u20132137 b\t Sim RR, Allender MC, Crawford LK et al. (2016) Ranavirus epizootic in captive eastern Q box turtles (Terrapene carolina carolina) with concurrent herpesvirus and mycoplasma infection: management and monitoring.\u00a0Journal of Zoo and Wildlife Medicine 47(1), 256\u2013270 R S Famotidine T (Pepcid*) POM U Formulations: Oral: 20 mg, 40 mg tablets. Action: Potent histamine (H2) receptor antagonist blocking V histamine-induced gastric acid secretion. It is many times more potent than cimetidine, but has poorer oral bioavailability (37%). W Use: Management of gastric and duodenal ulcers, idiopathic, X uraemic or drug-related erosive gastritis, oesophagitis, and hypersecretory conditions secondary to gastrinoma, mast cell Y neoplasia or short bowel syndrome. Reduction of vomiting due to gastric ulceration is typically achieved in about 2 weeks. However, Z animals should be treated for at least 2 weeks after the remission of clinical signs, so a minimum treatment duration of 28 days is","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 127 recommended. Currently cimetidine is the only antiulcer drug with A a veterinary market authorization. Has little effect on GI motility B in humans. C D Safety and handling: Normal precautions should be observed. E F Contraindications: No information available. G H Adverse reactions: In humans famotidine has fewer side effects I J than cimetidine. K L Drug interactions: Famotidine is devoid of many of the M N interactions of the H2 related antagonist cimetidine. O P DOSES Q R Mammals: Ferrets: 0.25\u20130.5 mg\/kg p.o., i.v., s.c. q24h; Rabbits: 0.5 S mg\/kg p.o., s.c., i.v. q12h; Guinea pigs: 0.4 mg\/kg p.o., s.c. q24h; T Chinchillas: 0.5 mg\/kg s.c. q24h; Primates: 0.5\u20130.8 mg\/kg p.o. q24h. U Birds, Reptiles, Amphibians, Fish: No information available. V W Febantel see Pyrantel X Y Fenbendazole Z (Bob Martin Easy to Use Wormer, Granofen, Lapizole, Panacur, Zerofen) NFA-VPS, ESPA Formulations: Oral: 222 mg\/g granules (22%); 20 mg\/ml oral suspension (2%); 25 mg\/ml oral suspension (2.5%); 100 mg\/ml oral suspension (10%); 187.5 mg\/g oral paste (18.75%). Action: Inhibits fumarate reductase system of parasites thereby blocking the citric acid cycle and also reduces glucose absorption by the parasite. Use: Treatment of oxyurids, ascarids (including larval stages), hookworms, whipworms, tapeworms (Taenia), Oslerus osleri, Aelurostrongylus abstrusus, Angiostrongylus vasorum, Capillaria aerophila, Ollulanus tricuspis, Physaloptera rara\u00a0and Paragonimus kellicotti\u00a0infections. Fenbendazole has 100% efficacy in clearing\u00a0Giardia cysts. It is used in rabbits for the treatment of Encephalitozoon cuniculi. Unlike some other benzimidazoles, fenbendazole is safe to use in pregnant animals. Used for the treatment of non-encysted gastrointestinal nematodes, some cestodes (Bothriocephalus) and external monogenean parasites in fish. Safety and handling: Normal precautions should be observed. Contraindications: No information available. Adverse reactions: Birds, especially vultures and storks, and some raptors, are more sensitive to adverse reactions affecting bone marrow, intestinal and liver functions. In pigeons and doves,","128 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A mortality of 50% has occurred at doses of 20 mg\/kg p.o. given on 3 consecutive days. Vomiting, depression and death within 96 h are B recorded in some raptors. Feather damage has also been reported in pigeons. Has been associated with profound leucopenia in Testudo C hermanni following two courses of 50 mg\/kg fenbendazole given daily for 5 days per course. Avoid in reptiles with suspected D septicaemia. Some species of fish (e.g. discus) may react adversely to some formulations of fenbendazole by immersion. The sudden E death of a large burden of nematodes may cause tissue damage or intestinal blockage. F Drug interactions: No information available. G DOSES Mammals: Rabbits:\u00a0E. cuniculi: 20 mg\/kg p.o. q24h for 28 days\u2006a; H Oxyuriasis: 50 ppm (50 mg\/kg) in feed for 5 days\u2006b; Primates: 50 mg\/ kg p.o. q24h for 3 days; Sugar gliders: 20\u201350 mg\/kg p.o. q24h I for 3 days, repeat in 14 days; Hedgehogs: 10\u201330 mg\/kg p.o. q24h for 5 days; Other small mammals: 20\u201350 mg\/kg p.o. q24h for 5 J consecutive days; the higher end of the range is suggested for giardiasis only. K Birds: L \u2022\t Nematodes\u2006c: 20\u2013100 mg\/kg p.o., administer 2 doses separated by 10 days; capillariasis: 25 mg\/kg p.o. q24h for 5 consecutive M days; Pigeons: 16 mg\/kg p.o. once, repeat after 10 days if necessary or 10\u201320 mg\/kg p.o. q24h for 3 days, repeat after 2 N weeks; Passerines: 20 mg\/kg p.o. q24h for 3 doses. Not advisable to give more than 50 mg\/kg in unfamiliar species. O \u2022\t Giardiasis: 50 mg\/kg p.o. q24h for 3 doses\u2006d. Reptiles: P \u2022\t Nematodes: 50\u2013100 mg\/kg p.o., per cloaca once or 20\u201325 mg\/ kg p.o., per cloaca q24h over 3\u20135 day course\u2006e; Repeated doses Q have been advised but may be unnecessary as complete effect may not be seen until 31 days post-treatment\u2006f. R \u2022\t Giardiasis and flagellates: 50 mg\/kg p.o. q24h for 3\u20135 days. Amphibians: 100 mg\/kg p.o., repeat in 2 weeks. S Fish: External monogenean parasites: 25 mg\/l by immersion for 12 h; Gastrointestinal nematodes: 50 mg\/kg p.o. q24h for 2 days, repeat in T 14 days. U References a\t Suter C, M\u00fcller-Doblies UU, Hatt JM and Deplazes P (2001) Prevention and treatment V of Encephalitozoon cuniculi\u00a0infection in rabbits with fenbendazole. Veterinary Record 148(15), 478\u2013480 b\t D\u00fcwel D and Brech K (1981) Control of oxyuriasis in rabbits by fenbendazole. W Laboratory Animal 15(2), 101\u2013105 c\t Lawrence K (1983) Efficacy of fenbendazole against nematodes of captive birds. Veterinary Record 112, 433\u2013434 X d\t Yazwinski TA, Andrews P, Holtzen H et al. (1986) Dose-titration of fenbendazole in the treatment of poultry nematodiasis. Avian Diseases 30(4), 716\u2013718 Y e\t Holt PE (1982) Efficacy of fenbendazole against the nematodes of reptiles. Veterinary Record 110, 302\u2013304 Z f\t Giannetto S, Brianti E, Poglayen G et al. (2007) Efficacy of oxfendazole and fenbendazole against tortoise (Testudo hermanni) oxyurids. Parasitology Research 100, 1069\u20131073","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 129 Fentanyl A B (Fentadon, Durogesic*, Fentanyl*, Fentora*, C Sublimaze*) POM-V CD SCHEDULE 2, POM CD D SCHEDULE 2 E F Formulations: Oral: 100 \u03bcg, 200 \u03bcg, 400 \u03bcg, 600 \u03bcg, 800 \u03bcg G H tablets. Injectable: 50 \u03bcg\/ml solution. Transdermal: 12.5 \u03bcg\/h, I 25 \u03bcg\/h, 50 \u03bcg\/h, 75 \u03bcg\/h, 100 \u03bcg\/h patches. J K Action: Synthetic pure mu (OP3) receptor agonist. L M Use: Very potent opioid analgesic (50 times more potent than N O morphine) used to provide profound intraoperative analgesia. Can P also be used at low dose rates for postoperative analgesia. Use of Q potent opioids during anaesthesia contributes to a balanced R anaesthesia technique, therefore the dose of other concurrently S administered anaesthetic agents should be reduced. Fentanyl has a T rapid onset of action after i.v. administration and short duration of U action (10\u201320 min depending on dose). After prolonged V administration (>4 hours) or high doses its duration of action is W significantly prolonged as the tissues become saturated. It can be X used intraoperatively to provide analgesia by intermittent bolus doses Y or by a continuous rate infusion. Postoperatively fentanyl can be given Z by continuous rate infusion to provide analgesia, doses at the low end of the dose range should be used and respiratory function monitored. Its clearance is similar to morphine whilst its elimination half-life is longer, reflecting its higher lipid solubility and volume of distribution. Safety and handling: Veterinary surgeons must undergo training in order to become authorized to prescribe transdermal fentanyl and receive the drug from veterinary wholesalers. The transdermal solution of fentanyl is very concentrated with the potential to cause opioid overdose (associated with respiratory depression) if absorbed systemically by humans (e.g. through contact with the skin or mucosal surfaces such as the eyes and mouth). Personal protective clothing consisting of latex or nitrile gloves, eye protection and suitable protective clothing must be worn when handling the product. Following application to the skin, the site must not be touched for at least 5 min until the solution is dry. It is advisable to wear gloves when handling animals to which transdermal fentanyl has been applied for up to 72 hours following application or to wash hands immediately after handling the animal in this time window. Owners should be advised that children <15 kg body weight should not be allowed to come into contact with animals treated with transdermal fentanyl until 72 hours after application. The manufacturer provides information to give to the owner at the time of discharge, detailing the effects of the drug and the risks of human exposure. Other animals should not be allowed to come into contact with the site of application on treated animals for 72 hours following application. If animals are sent home with transdermal fentanyl patches the owners must be warned about the dangers of patch ingestion by humans or other animals.","130 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Contraindications: No information available. Adverse reactions: Intraoperative administration is likely to cause B respiratory depression, therefore, respiration should be monitored and facilities must be available to provide positive pressure C ventilation. Rapid i.v. injection can cause severe bradycardia, even asystole, therefore the drug should be given slowly. A reduction in D heart rate is likely whenever fentanyl is given, atropine can be administered to counter bradycardia if necessary. Apart from the E effects on heart rate, fentanyl has limited other effects on cardiovascular function when used at clinical dose rates. F Drug interactions: Fentanyl can be used to reduce the dose G requirement for other anaesthetic drugs in patients with cardiovascular instability or systemic disease. H DOSES I Mammals: Ferrets: 10\u201330 \u03bcg (micrograms)\/kg\/h i.v. CRI, reduce to 1.25\u20135 \u03bcg\/kg\/h for postoperative analgesia; Rabbits: 7.5 \u03bcg\/kg q20min; 30\u2013100 \u03bcg\/kg\/h by CRI during anaesthesia; Primates: 5\u201310 J \u03bcg\/kg i.v. or 25 \u03bcg\/kg\/h CRI\u2006a. K Birds: Red-tailed hawks:\u00a020 \u03bcg (micrograms) bolus i.v. followed by 0.2\u20130.5 \u03bcg\/kg\/min i.v. infusion reduced isoflurane requirement without effect on heart rate or blood pressure\u2006b; White (umbrella) L cockatoos: 0.02 mg\/kg i.m. produced no analgesia but was well M tolerated; 0.2 mg\/kg produced some analgesia but signs of hyperactivity in some birds in first 15\u201330 min after administration\u2006c. N Reptiles: 12 \u03bcg (micrograms)\/h transdermal fentanyl patch results in plasma concentrations above analgesic threshold in mammals, O when tested in ball pythons\u2006d and prehensile-tailed skinks\u2006e. Analgesic efficacy not established, although anecdotally may be useful in P snakes. Amphibians, Fish: No information available. Q References R a\t Valverde CR, Mama KR, Kollias-Baker C, Steffey EP and Baggot JD (2000) Pharmacokinetics and cardiopulmonary effects of fentanyl in isoflurane- anaesthetized rhesus monkeys (Macaca mulatta).\u00a0American Journal of Veterinary S Research 61(8), 931\u2013934 b\t Pavez JC, Hawkins MG, Pascoe PJ, Knych HKD and Kass PH (2011) Effect of fentanyl T target controlled infusions on isoflurane minimum anaesthetic concentration and cardiovascular function in red tailed hawks (Buteo jamaicensis). Veterinary Anaesthesia and Analgesia 38(4), 344\u2013351 U c\t Hoppes S, Flammer K, Hoersch K, Papich M and Paul-Murphy J (2003) Disposition and analgesic effects of fentanyl in white cockatoos (Cacatua alba). Journal of Avian Medicine and Surgery\u00a017(3), 124\u2013131 V d\t Kharbush RJ, Gutwillig A, Hartzler KE et al. (2017) Antinociceptive and respiratory effects following application of transdermal fentanyl patches and assessment of brain W \u03bc-opioid receptor mRNA expression in ball pythons. American Journal of Veterinary Research 78(7), 785\u2013795 e\t Gamble KC (2008) Plasma fentanyl concentrations achieved after transdermal X fentanyl patch application in prehensile-tailed skinks, Corucia zebrata. Journal of Herpetological Medicine and Surgery 18(3), 81\u201385 Y Z","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 131 Fentanyl\/Fluanisone A B (Hypnorm) POM-V CD SCHEDULE 2 C D Formulations: Injectable: 0.2 mg\/ml fentanyl with 10 mg\/ml E F fluanisone. G H Action: Fentanyl is a pure mu opioid agonist and fluanisone is a I J butyrophenone; the combination produces neuroleptanalgesia. K L Use: Licensed for use in rabbits, guinea pigs, mice and rats. Sedation M N and analgesia for restraint and to allow minor procedures to be O carried out in mice, rats, rabbits, guinea pigs and primates. Combined P with a benzodiazepine it can be used to produce anaesthesia with Q muscle relaxation for surgery. It can be used for premedication prior R to induction of anaesthesia with propofol or alfaxalone in rabbits. S Fentanyl\/fluanisone produces a long duration of sedation and T analgesia in small mammals (30\u201360 min), the duration of action is U dependent on dose and varies between species. When used in V combination with a benzodiazepine to produce anaesthesia, the W lowest end of the dose range of fentanyl\/fluanisone should be used. X Hypnorm is miscible with midazolam at appropriate dilutions, Y enabling a single injection to produce anaesthesia. Duration of Z anaesthesia is approximately 20\u201340 min, although recovery can be very prolonged. Various dose regimens for different species have been published. Prolonged respiratory depression in the recovery period can be avoided by the administration of a partial mu agonist (buprenorphine) at the end of the procedure. This will reverse respiratory depression induced by fentanyl and provide continued analgesia. Small mammals should be weighed before drug administration, accurate dosing is imperative to prevent overdose. Oxygen supplementation via a face mask is recommended during sedation and anaesthesia of all animals. Safety and handling: Normal precautions should be observed. Contraindications: Animals with pre-existing respiratory compromise. Adverse reactions: Respiratory depression can occur when given in high doses, particularly during the recovery period. Administration of buprenorphine in the recovery period can ameliorate respiratory depression and sedation, and provide ongoing analgesia. Measures should be taken to maintain normothermia during the sedation\/ anaesthesia and recovery period. Drug interactions: No information available. DOSES When used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species. Mammals: Rabbits: 0.1\u20130.5 ml\/kg i.m.; Guinea pigs: 0.5\u20131 ml\/kg i.m.; Rats: 0.2\u20130.5 ml\/kg i.m., i.p.; Mice: 0.1\u20130.5 ml\/kg i.p.; Primates: 0.1\u20130.3 ml\/kg i.m. Doses at the highest 50% of these ranges are associated with extremely long recoveries and potentially","132 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A hypothermia. Reversal with partial or complete opioid antagonists may be required in such cases. Doses for sick animals should start at B the lowest end of the range. Birds, Reptiles, Amphibians, Fish: No information available. C D Finasteride E (Proscar*) POM Formulations: Oral: 5 mg tablet. F Action: Competitively inhibits dihydrotestosterone (DHT) G production within the prostate. DHT is the main hormonal stimulus for the development of benign prostatic hyperplasia. H Use: Treatment of benign prostatic hyperplasia associated with adrenal gland disease. I Safety and handling: Women of child-bearing age should avoid J handling crushed or broken tablets as finasteride is potentially teratogenic. K Contraindications: Do not use in breeding ferrets. L Adverse reactions: Secreted into semen and causes fetal anomalies. M Drug interactions: No information available. N DOSES Mammals: Ferrets: 5 mg\/kg p.o. q24h. O Birds, Reptiles, Amphibians, Fish: No information available. P Fipronil Q (Amflee Combo Spot-on Solution for Cats and R Ferrets, Bob Martin Clear Plus Spot-on Solution for Cats and Ferrets, Certifect, Effipro, Eliminall, S Felevox, Fiproclear Combo Spot-on Solution, T Fipronil, Fiprospot, Fleanil Duo Spot-on Solution for Cats and Ferrets, Frontline Combo Spot U On Cat, Frontline Plus Spot On Cat, Fyperix V Combo Spot-on Solution for Cats and Ferrets, PrestiGon Combo Spot-on Solution for Cats W and Ferrets) NFA-VPS, POM-V X Formulations: Topical: 10% w\/v fipronil spot-on pipettes in a wide Y range of sizes (Effipro, Frontline); with S-methoprene (Frontline Combo); with S-methoprene and amitraz (Certifect). Also 0.25% w\/v Z fipronil spray in alcohol base (Effipro and Frontline sprays) in a range of sizes.","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 133 Action: Fipronil interacts with ligand-gated (GABA) chloride A B channels, blocking pre- and postsynaptic transfer of chloride ions, C resulting in death of parasites on contact. D E Use: Treatment of fleas, lice and ticks in mammals and birds. F G Treatment of mites and ticks in reptiles. Has been used to treat H Hirstiella mites in green iguanas, but still needs further safety I evaluation in other species. Beware of use in juvenile reptiles and J immediately after skin slough due to increased permeability of skin K and associated toxicity. Treatment of the environment is also L recommended. Care with overuse of alcohol-based spray in birds\u2006a. M N Safety and handling: Normal precautions should be observed. O P Contraindications: Do not use in rabbits. Beware of use in Q R debilitated reptiles, those which have recently shed their skin and in S small species where overdosage and toxicity may occur. May be T harmful to aquatic organisms. U V Adverse reactions: Local pruritus or alopecia may occur at the W X site of application. Y Z Drug interactions: A low dose of amitraz has been shown to have a synergistic effect on the speed of tick kill, thus reducing the risk of transmission for tick-borne pathogens. DOSES Mammals: Ferrets: spray 3\u20136 ml\/kg (6\u201312 pumps\/kg 100 ml application) q30\u201360d; One spot-on pipette of 0.5 ml\/animal (50 mg fipronil, 60 mg S-methoprene) applied topically to back of neck; Rodents: 7.5 mg\/kg topically (15 pumps\/kg 100 ml application) q30\u201360d. Other mammals: apply lightly q14d. Birds: Use spray form q30\u201360d. Apply to cotton wool and dab behind head, under wings and at base of tail (raptors\/parrots) or lightly under each wing (pigeons\/passerines). Reptiles: Spray on to cloth first then wipe over surface of reptile q7\u201314d until negative for ectoparasites. Amphibians, Fish: Not indicated. References a\t Kitulagodage M, Astheimer LB and Buttemer WA (2008) Diacetone alcohol, a dispersant solvent, contributes to acute toxicity of a fipronil-based insecticide in a passerine bird. Ecotoxicology and Enviromental Safety 71(2), 597\u2013600 Florfenicol (Florocol, Nuflor) POM-V Formulations: Injectable: 300 mg\/ml, 450 mg\/ml solution. Oral: 500 mg\/g powder. Action: Bacteriostatic antimicrobial that acts by binding to the 50S ribosomal subunit of susceptible bacteria, preventing bacterial protein synthesis.","134 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Use: Treatment of bacterial diseases in fish. Safety and handling: Normal precautions should be observed. B Contraindications: No information available. C Adverse reactions: No information available. D Drug interactions: No information available. E DOSES Fish: 25\u201350 mg\/kg i.m., intracoelomic q24h or 5\u201350 mg\/kg p.o. F q24h for 10 days\u2006a,b. Mammals, Birds, Reptiles, Amphibians: No information G available. References H a\t Yanong RP, Curtis EW, Simmons R et al. (2005) Pharmacokinetic studies of florfenicol in koi carp and threespot gourami Trichogaster trichopterus\u00a0after oral and I intramuscular treatment. Journal of Aquatic Animal Health\u00a017(2), 129\u2013137 b\t Lewbart G, Papich MG and Whitt-Smith D (2005) Pharmacokinetics of florfenicol in the red pacu (Piaractus brachypomum) after single dose intramuscular injection. J Journal of Veterinary Pharmacology and Therapeutics\u00a028, 317\u2013319 K Flubendazole L (Anti Fluke &Wormer, Flubenol, Flukasol M Suspension, Fluke-M) ESPA Formulations: Immersion: 5% powder (Fluke-M); <0.8% liquid N (Flukasol Suspension), 1% liquid (Anti Fluke & Wormer). O Action: Benzimidazoles bind to a structural protein of the parasite microtubules, important organelles involved in major cell processes, P causing paralysis, death and expulsion of the parasites. Use: Treatment of monogenetic trematode ectoparasites (e.g. skin Q and gill flukes) and internal nematodes in fish. Used to kill snails and hydra in aquaria. Flubendazole has a low solubility but a high potency. R Safety and handling: Normal precautions should be observed. S Contraindications: No information available. T Adverse reactions: No information available. Drug interactions: No information available. U DOSES V Fish: 2 mg\/l by prolonged immersion once and change 30% of water after 6 days. Follow manufacturer\u2019s recommendations for W proprietary formulations. Mammals, Birds, Reptiles, Amphibians: No information X available. Y Z","BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets 135 Flucloxacillin A B (Floxapen*, Flucloxacillin*) POM C D Formulations: Injectable: Flucloxacillin sodium: 250 mg, 500 mg, E F 1 g powders for reconstitution. Oral: Flucloxacillin sodium: 250 mg G or 500 mg capsules; powder for reconstitution with water giving a H final concentration of 125 mg\/5 ml, 250 mg\/5 ml. Formulations of I flucloxacillin with ampicillin are available (Co-fluampicil, Magnapen). J K Action: Beta-lactamase-resistant, narrow-spectrum beta-lactam L M antibiotic. It binds to penicillin-binding proteins, decreasing bacterial N cell wall strength and rigidity, and affecting cell division, growth and O septum formation. Flucloxacillin is bactericidal and works in a P time-dependent fashion. Q R Use: Stable in gastric acid so can be given orally but food significantly S T reduces its bioavailability. It is less active than penicillin G or V against U Streptococcus and obligate anaerobic bacteria, and is indicated for V the treatment of infections caused by beta-lactamase-producing W Staphylococcus. Patients with significant renal or hepatic dysfunction X may need dosage adjustment. The amount of sodium in flucloxacillin Y sodium may be clinically important for patients on restricted sodium Z intakes. Although flucloxacillin is absorbed from the GI tract, food has a significant inhibitory effect on its bioavailability; doses must be given on an empty stomach therefore limiting potential use in rabbits and rodents. As flucloxacillin kills in a time-dependent fashion, dosing regimens should be designed to maintain tissue concentrations above the MIC throughout the interdosing interval. Use with care in hepatic disease or hepatic impairment. Safety and handling: Normal precautions should be observed. Contraindications: Do not administer to animals with a history of sensitivity to beta-lactam antimicrobials. Use of penicillins should be avoided in rabbits, other small herbivores, hamsters and gerbils especially via the oral route. Adverse reactions: Nausea, diarrhoea and skin rashes are the commonest adverse effects. Cholestatic hepatitis has been reported in humans. Avoid oral administration in small herbivores (e.g. rabbits), hamsters and gerbils as penicillins can cause fatal enterotoxaemia. Drug interactions: Avoid the concomitant use of bacteriostatic antibiotics. The aminoglycosides (e.g. gentamicin) may inactivate penicillins when mixed together in parenteral solutions. A synergistic effect is seen when beta-lactam and aminoglycoside antimicrobials are used concurrently. DOSES See Appendix for guidelines on responsible antibacterial use. Mammals: Rats: 200 mg\/kg s.c. q8h\u2006a. Birds, Reptiles, Amphibians, Fish: No information available. References a\t Gisby J, Beale AS, Bryant JE and Toseland CD (1994) Staphylococcal osteomyelitis \u2013 a comparison of co-amoxiclav with clindamycin and flucloxacillin in an experimental rat model. Journal of Antimicrobial Chemotherapy 34(5), 755\u2013764","136 BSAVA Small Animal Formulary 10th edition: Part B \u2013 Exotic Pets A Fluconazole (Diflucan*, Fluconazole*) POM B Formulations: Oral: 50 mg, 150 mg, 200 mg capsules; 40 mg\/ml C suspension. Injectable: 2 mg\/ml solution. Action: Inhibition of the synthesis of ergosterol in fungal cell D membranes, thus causing increased cell wall permeability and allowing leakage of cellular contents. E Use: Effective against Blastomyces, Candida, Cryptococcus, F Coccidioides, Histoplasma and Microsporum canis infections and variably effective against Aspergillus and Penicillium infections. G Has been used for treatment of dermatophytosis in green iguanas. In amphibians, it prolonged survival in frogs with chytridiomycosis H but did not prevent mortality. It attains therapeutic concentrations in the CNS and respiratory tract. It is excreted by the kidney, I producing high concentrations in urine. Reduce dose in animals with renal impairment and liver disease. This drug should be J used until clinical signs have resolved and the organism is no longer present; this may take up to 2 months in some cases. K Safety and handling: Normal precautions should be observed. L Contraindications: Do not use in pregnant\/lactating animals. M Adverse reactions: Adverse effects may include nausea and diarrhoea. May be hepatotoxic. May cause vomiting in birds. N Drug interactions: Fluconazole (due to inhibition of cytochrome P450-dependent liver enzymes) may increase plasma theophylline O concentrations. In humans, fluconazole has led to terfenadine toxicity when the two drugs were administered together. P Fluconazole increases ciclosporin blood levels. Q DOSES Mammals: Rabbits: 25\u201343 mg\/kg i.v. infusion (slow) q12h; 37.5 mg\/ R kg p.o. q12h for Aspergillus keratitis; 5 mg\/kg p.o. q24h for cryptococcal meningitis. S Birds: 10\u201320 mg\/kg p.o. q24\u201348h\u2006a. Reptiles: 5 mg\/kg p.o. q24h (iguanas with dermatophytosis). T Amphibians: 60 mg\/kg p.o. q24h. Baths at 25 mg\/l prolonged survival in frogs with chytridiomycosis but did not prevent mortality\u2006b. U Fish: No information available. V References a\t Flammer K and Papich M (2006) Pharmacokinetics of fluconazole after oral W administration of single and multiple doses in African grey parrots. American Journal of Veterinary Research 67(3), 417\u2013422 b\t Berger L, Speare R, Marantelli G and Skerratt LF (2009) A zoospore inhibition X technique to evaluate the activity of antifungal compounds against Batrachochytrium dendrobatidis and unsuccessful treatment of experimentally infected green tree frogs (Litoria caerulae) by fluconazole and benzalkonium chloride. Research in Veterinary Y Science 87(1), 106\u2013110 Z"]
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